Provider Demographics
NPI:1770696296
Name:DAWSON, ALICIA A (RPH)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:A
Last Name:DAWSON
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:PO BOX 700
Mailing Address - Street 2:
Mailing Address - City:MC DOWELL
Mailing Address - State:KY
Mailing Address - Zip Code:41647-0700
Mailing Address - Country:US
Mailing Address - Phone:606-377-1088
Mailing Address - Fax:606-377-2626
Practice Address - Street 1:9575 KY RT 122
Practice Address - Street 2:SUITE 5
Practice Address - City:MC DOWELL
Practice Address - State:KY
Practice Address - Zip Code:41647
Practice Address - Country:US
Practice Address - Phone:606-377-2006
Practice Address - Fax:606-377-2626
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10414183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist