Provider Demographics
NPI:1902105554
Name:DICKINSON, JAMES LEWIS (BS)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LEWIS
Last Name:DICKINSON
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 W MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-4577
Mailing Address - Country:US
Mailing Address - Phone:256-249-0270
Mailing Address - Fax:
Practice Address - Street 1:101 ASBURY ST
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2570
Practice Address - Country:US
Practice Address - Phone:256-362-9540
Practice Address - Fax:256-362-9905
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9517183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL9517OtherPHARMACIST LICENSE NUMBER