MEDICARE: MRS. AMY JANE DICKSON RPH

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	RI24909	NJ
2	183500000X	Pharmacist	047178	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568643617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY JANE DICKSON RPH

Provider Business Mailing Address
First Line	:	17 GRAND COVE WAY
Second Line	:
City	:	EDGEWATER
State	:	NJ
Zip	:	07020-7222
Country	:	US
Telephone Number	:	201-927-6076
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 SPRING VALLEY MARKETPLACE
Second Line	:
City	:	SPRING VALLEY
State	:	NY
Zip	:	10977-5213
Country	:	US
Telephone Number	:	845-371-5811
Fax Number	:	845-371-5811

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

Provider Enumeration Date	:	11/16/2007
Last Update Date	:	04/04/2008

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