Individual
KYLE THOMAS DICKENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH,PHARMD,MHA
Contact information
Practice address
30 E OAK ST, LEBANON, OR 97355-3222
(541) 451-8020
(541) 451-8027
Mailing address
582 CASTING ST SE, ALBANY, OR 97322-4911
(209) 581-8138
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH-0017457
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RPH-0017457
OREGON BOARD OF PHARMACY
OR
Enumeration date
09/14/2019
Last updated
11/29/2021
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