Individual
MATTHEW DICKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
104 TN-52 W, PORTLAND, TN 37148
(615) 325-4058
Mailing address
1401 3RD AVE N APT 101, NASHVILLE, TN 37208-3269
(770) 778-0909
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
42646
TN
Other
Enumeration date
04/20/2021
Last updated
04/20/2021
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