MEDICARE: MR. PETER DICKASON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	57021	CA

General Provider Information

NPI Number	:	1407070170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER DICKASON

Provider Business Mailing Address
First Line	:	933 HELENE CT
Second Line	:
City	:	ROHNERT PARK
State	:	CA
Zip	:	94928-1460
Country	:	US
Telephone Number	:	707-584-7651
Fax Number	:	707-544-6147

Provider Business Practice Location Address
First Line	:	1551 FARMERS LN
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-7525
Country	:	US
Telephone Number	:	707-544-4050
Fax Number	:	707-544-6147

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	07/08/2007

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Directions to “ MR. PETER DICKASON ” Practice Location

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