Provider Demographics
NPI:1942925458
Name:DICKTER, PAIGE ALLISON
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:ALLISON
Last Name:DICKTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 GREECE RIDGE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-2825
Mailing Address - Country:US
Mailing Address - Phone:585-225-1597
Mailing Address - Fax:
Practice Address - Street 1:600 GREECE RIDGE CENTER DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-2825
Practice Address - Country:US
Practice Address - Phone:585-225-1597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068207183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist