Provider Demographics
NPI:1023999471
Name:DIX, JIM (PHARMD)
Entity type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:DIX
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-5125
Mailing Address - Country:US
Mailing Address - Phone:435-649-6264
Mailing Address - Fax:435-655-7176
Practice Address - Street 1:1760 PARK AVE
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-5125
Practice Address - Country:US
Practice Address - Phone:435-649-6264
Practice Address - Fax:435-655-7176
Is Sole Proprietor?:No
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT374025-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist