Provider Demographics
NPI:1851694111
Name:DICKERSON, RACHELLE (RPH)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:DICKERSON
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 1:2007 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-3801
Mailing Address - Country:US
Mailing Address - Phone:304-428-4705
Mailing Address - Fax:304-424-6643
Practice Address - Street 1:2007 7TH ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-3801
Practice Address - Country:US
Practice Address - Phone:304-428-4705
Practice Address - Fax:304-424-6643
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV5781183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist