MEDICARE: DR. DANELLA DEONDRA DIXON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS53805	FL

General Provider Information

NPI Number	:	1528589637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANELLA DEONDRA DIXON

Provider Business Mailing Address
First Line	:	3400 OLD BAINBRIDGE RD APT 305
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32303-2678
Country	:	US
Telephone Number	:	850-322-8008
Fax Number	:

Provider Business Practice Location Address
First Line	:	1208 W JEFFERSON ST
Second Line	:
City	:	QUINCY
State	:	FL
Zip	:	32351-2126
Country	:	US
Telephone Number	:	850-875-3021
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2017
Last Update Date	:	06/28/2017

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