MEDICARE: LIDIA TERESA DICKINSON 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	S11999	AZ

General Provider Information

NPI Number	:	1801609987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIDIA TERESA DICKINSON RPH

Provider Business Mailing Address
First Line	:	8113 N 8TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-5634
Country	:	US
Telephone Number	:	602-705-1136
Fax Number	:

Provider Business Practice Location Address
First Line	:	706 W MONTECITO AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-2814
Country	:	US
Telephone Number	:	602-277-4714
Fax Number	:

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

Provider Enumeration Date	:	01/31/2025
Last Update Date	:	01/31/2025

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Directions to “ LIDIA TERESA DICKINSON RPH” Practice Location

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