MEDICARE: MR. PAUL ARTHUR DIMMOCK B.S.

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	8996	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8996	OTHER	CT	RPH LICENSE #

General Provider Information

NPI Number	:	1982882163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL ARTHUR DIMMOCK B.S.

Provider Business Mailing Address
First Line	:	11 HAYWAGON DR
Second Line	:
City	:	OLD LYME
State	:	CT
Zip	:	06371-2081
Country	:	US
Telephone Number	:	860-235-7778
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 WASHINGTON ST
Second Line	:
City	:	MIDDLETOWN
State	:	CT
Zip	:	06457-2912
Country	:	US
Telephone Number	:	860-344-1551
Fax Number	:

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

Provider Enumeration Date	:	02/10/2008
Last Update Date	:	02/10/2008

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