MEDICARE: DR. JOHN DICKSON PHARMD

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	PH233242	MA

General Provider Information

NPI Number	:	1811582257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN DICKSON PHARMD

Provider Business Mailing Address
First Line	:	1277 LIBERTY ST
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01104-1165
Country	:	US
Telephone Number	:	413-732-7040
Fax Number	:

Provider Business Practice Location Address
First Line	:	1277 LIBERTY ST
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01104-1165
Country	:	US
Telephone Number	:	413-732-7040
Fax Number	:

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

Provider Enumeration Date	:	03/08/2021
Last Update Date	:	03/08/2021

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Directions to “ DR. JOHN DICKSON PHARMD” Practice Location

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