MEDICARE: REBECCA DICKERSON

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	PS54055	FL

General Provider Information

NPI Number	:	1992175350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA DICKERSON

Provider Business Mailing Address
First Line	:	3106 CREEKDALE CT
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-7316
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 GRIFFIN RD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33810-6760
Country	:	US
Telephone Number	:	863-858-1146
Fax Number	:

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

Provider Enumeration Date	:	09/29/2015
Last Update Date	:	09/29/2015

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Directions to “ REBECCA DICKERSON ” Practice Location

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