MEDICARE: MS. JANE G. DICKERSON R.PH.

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	10362	AL

General Provider Information

NPI Number	:	1447388715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANE G. DICKERSON R.PH.

Provider Business Mailing Address
First Line	:	2451 LANCASTER CIR
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-4421
Country	:	US
Telephone Number	:	205-991-6684
Fax Number	:

Provider Business Practice Location Address
First Line	:	2090 COLUMBIANA RD STE 1200
Second Line	:
City	:	VESTAVIA HILLS
State	:	AL
Zip	:	35216-2153
Country	:	US
Telephone Number	:	205-552-1702
Fax Number	:	205-521-7085

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

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	04/26/2019

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