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General NPI Number Information
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NPI Number | 1831254143
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Entity Type | Individual
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Provider Name | ROBERT PAUL DICKERSON
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Gender | Male
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1009 N CHURCH AVE
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City | MULBERRY
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State | FL
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Zip | 33860-2039
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Country | US
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Telephone | 863-425-1101
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Fax |
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Provider Business Mailing Address
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Address Line | 5080 LAKE PIERCE DR
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City | LAKE WALES
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State | FL
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Zip | 33898-8884
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Country | US
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Telephone | 863-439-3506
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Fax | 863-439-3506
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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 | PS15066
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License Number State | FL
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