MEDICARE: DAVID C DICKSON

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	PD08247	AR

General Provider Information

NPI Number	:	1730805631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID C DICKSON

Provider Business Mailing Address
First Line	:	237 MAIN ST
Second Line	:
City	:	STAMPS
State	:	AR
Zip	:	71860-2827
Country	:	US
Telephone Number	:	870-533-4311
Fax Number	:	870-533-2731

Provider Business Practice Location Address
First Line	:	237 MAIN ST
Second Line	:
City	:	STAMPS
State	:	AR
Zip	:	71860-2827
Country	:	US
Telephone Number	:	870-533-4311
Fax Number	:	870-533-2731

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

Provider Enumeration Date	:	10/13/2022
Last Update Date	:	10/13/2022

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Directions to “ DAVID C DICKSON ” Practice Location

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