Dickenson Pharmacy PC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

0201004468 Issued in VA

Legal business name

DICKENSON PHARMACY PC

Doing business as

Dickenson Drug Company

Practice address

580 N Main St
Rural Retreat, VA 24368-2564

Phone

(276) 686-5073

Fax

(276) 686-5074

NPI assigned

May 21, 2012

Last updated

Nov 29, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shannon Dickenson

Title

Pic/Owner

Phone

(276) 617-8144

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Dickenson Drug Company Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1337558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480377600000",
    "number": "1922368240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 215",
            "city": "RURAL RETREAT",
            "state": "VA",
            "postal_code": "243680215",
            "telephone_number": "276-686-5073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 N MAIN ST",
            "city": "RURAL RETREAT",
            "state": "VA",
            "postal_code": "243682564",
            "telephone_number": "276-686-5073",
            "fax_number": "276-686-5074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DICKENSON PHARMACY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-21",
        "last_updated": "2016-11-29",
        "status": "A",
        "authorized_official_last_name": "DICKENSON",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "PIC/OWNER",
        "authorized_official_telephone_number": "276-617-8144"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "VA",
            "license": "0201004468",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1922368240",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2135292",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dickenson Drug Company",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Blue Ridge Medical Management Corporation (MSMG ENT Rurl)
• Lily Mae Boyd, DC
• Julie Lynn Coulsey, MA
• Cplace Rural Retreat SNF, LLC (Carrington Place of Rural Retreat)
• Miranda Paige Davidson
• Alma J Dunford, CPHT
• H2 Rehabilitation Services of Virginia, LLC (H2 Health)
• Tracie Jones Havens, RN
• Cassidy Hensley, FNP-BC
• Robert Douglas Humphrey Jr., D.D.S.

• Community/Retail Pharmacy in Rural Retreat, VA
• Providers in Rural Retreat, VA by specialty
• Community/Retail Pharmacy in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.