Provider Demographics
NPI:1710246707
Name:RICKETTS, PAMELA DIANE (PHARMD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:DIANE
Last Name:RICKETTS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:DIANE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6455 MACHINE ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN PROVING GROUND
Mailing Address - State:MD
Mailing Address - Zip Code:21005-5213
Mailing Address - Country:US
Mailing Address - Phone:410-278-1936
Mailing Address - Fax:410-278-3520
Practice Address - Street 1:6455 MACHINE ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN PROVING GROUND
Practice Address - State:MD
Practice Address - Zip Code:21005-5213
Practice Address - Country:US
Practice Address - Phone:410-278-1936
Practice Address - Fax:410-278-3520
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17120183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist