Organization
DICKENSON PHARMACY PC
Active
Other names
Dickenson Drug Company
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON DICKENSON (PIC/OWNER)
(276) 617-8144
Entity
Organization
Contact information
Practice address
580 N MAIN ST, RURAL RETREAT, VA 24368-2564
(276) 686-5073
(276) 686-5074
Mailing address
PO BOX 215, RURAL RETREAT, VA 24368-0215
(276) 686-5073
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0201004468
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1922368240
—
VA
01
—
2135292
PK
—
Enumeration date
05/21/2012
Last updated
11/29/2016
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