Healthcare Provider Details

I. General information

NPI: 1780024679
Provider Name (Legal Business Name): DIXIE INDEPENDENT ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 ETOWAH ST
ALTOONA AL
35952
US

IV. Provider business mailing address

PO BOX 7
ALTOONA AL
35952
US

V. Phone/Fax

Practice location:
  • Phone: 205-589-6557
  • Fax: 205-589-6553
Mailing address:
  • Phone: 205-589-6557
  • Fax: 205-589-6553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number101165
License Number StateAL

VIII. Authorized Official

Name: DR. GABRIEL ARGO
Title or Position: OWER
Credential: PHARMD
Phone: 205-589-6557