Provider Demographics
NPI:1790097285
Name:DICKSON, KATHERINE VIRGINIA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:VIRGINIA
Last Name:DICKSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 N GREAT NECK RD STE 1216
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2268
Mailing Address - Country:US
Mailing Address - Phone:757-481-5001
Mailing Address - Fax:757-481-4970
Practice Address - Street 1:1340 N GREAT NECK RD STE 1216
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2268
Practice Address - Country:US
Practice Address - Phone:757-481-5001
Practice Address - Fax:757-481-4970
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009460183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist