MEDICARE: MRS. DEBRA ANN DIXON RPH

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	007776	SC

General Provider Information

NPI Number	:	1548388267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBRA ANN DIXON RPH

Provider Business Mailing Address
First Line	:	3825 RIVER HILLS DR
Second Line	:
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-8443
Country	:	US
Telephone Number	:	843-399-0489
Fax Number	:

Provider Business Practice Location Address
First Line	:	4125 MAIN ST
Second Line	:
City	:	LORIS
State	:	SC
Zip	:	29569-3023
Country	:	US
Telephone Number	:	843-756-4021
Fax Number	:

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

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/08/2007

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