Provider Demographics
NPI:1760732614
Name:DICKERSON, RONALD ELI JR (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:ELI
Last Name:DICKERSON
Suffix:JR
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 NORTH VAN LINGLE MUNGO BLVD
Mailing Address - Street 2:
Mailing Address - City:PAGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29728
Mailing Address - Country:US
Mailing Address - Phone:843-672-2420
Mailing Address - Fax:
Practice Address - Street 1:205 NORTH VAN LINGLE MUNGO BLVD
Practice Address - Street 2:
Practice Address - City:PAGELAND
Practice Address - State:SC
Practice Address - Zip Code:29728
Practice Address - Country:US
Practice Address - Phone:843-672-2420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC011828183500000X
NC20482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist