Provider Demographics
NPI:1952658684
Name:DICKSON, DAVID LUDWICK
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LUDWICK
Last Name:DICKSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11380 S VIRGINIA ST
Mailing Address - Street 2:APT 2034
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-9035
Mailing Address - Country:US
Mailing Address - Phone:719-231-4054
Mailing Address - Fax:
Practice Address - Street 1:12645 S VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-4803
Practice Address - Country:US
Practice Address - Phone:775-853-9887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV18344183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist