Provider Demographics
NPI:1548529506
Name:DICKEY, JEFMAR DANIEL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JEFMAR
Middle Name:DANIEL
Last Name:DICKEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:842 E POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-5540
Mailing Address - Country:US
Mailing Address - Phone:559-359-3525
Mailing Address - Fax:
Practice Address - Street 1:842 E POPLAR AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-5540
Practice Address - Country:US
Practice Address - Phone:559-359-3525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65988183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist