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General NPI Number Information
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NPI Number | 1447063276
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Entity Type | Individual
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Provider Name | RICHANQUA J DICKERSON
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Gender | Female
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 17122 AIRLINE HWY
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City | PRAIRIEVILLE
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State | LA
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Zip | 70769-3402
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Country | US
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Telephone | 225-673-9971
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Fax |
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Provider Business Mailing Address
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Address Line | 410 W SUNCREST LOOP
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City | SLIDELL
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State | LA
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Zip | 70458-1674
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Country | US
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Telephone | 504-756-0196
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Fax |
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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 | PST.025614
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License Number State | LA
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