Anita Dickerson
Individual provider Active NPI Pharmacist · Humboldt, TN
NPI 1134864846 · NPPES record last updated Apr 28, 2022
Key facts
- NPI
- 1134864846
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 45747 (TN)
- Practice address
- 2401 N Central Ave
Humboldt, TN 38343-1753 - Phone
- (731) 784-2613
- NPI assigned
- Apr 28, 2022
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 45747 | TN | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 45747 | TN | Yes |
Addresses
Primary practice location
2401 N Central Ave
Humboldt, TN 38343-1753
Mailing address
2401 N Central Ave
Humboldt, TN 38343-1753
Phone (731) 784-2613
Other providers in Humboldt, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 28, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.