Individual
MICHAEL DEAN DICKENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2490
(208) 381-4501
Mailing address
3876 TATTENHAM AVE, BOISE, ID 83713-3657
(208) 381-2490
(208) 381-4501
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P4854
ID
Other
Enumeration date
05/15/2007
Last updated
07/08/2007
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