Provider Demographics
NPI:1548388267
Name:DIXON, DEBRA ANN (RPH)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:ANN
Last Name:DIXON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 RIVER HILLS DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-8443
Mailing Address - Country:US
Mailing Address - Phone:843-399-0489
Mailing Address - Fax:
Practice Address - Street 1:4125 MAIN ST
Practice Address - Street 2:
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-3023
Practice Address - Country:US
Practice Address - Phone:843-756-4021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC007776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist