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General NPI Number Information
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NPI Number | 1407070170
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Entity Type | Individual
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Provider Name | MR. PETER DICKASON
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Gender | Male
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1551 FARMERS LN
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City | SANTA ROSA
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State | CA
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Zip | 95405-7525
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Country | US
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Telephone | 707-544-4050
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Fax | 707-544-6147
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Provider Business Mailing Address
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Address Line | 933 HELENE CT
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City | ROHNERT PARK
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State | CA
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Zip | 94928-1460
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Country | US
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Telephone | 707-584-7651
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Fax | 707-544-6147
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 57021
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License Number State | CA
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