Healthcare Provider Details

I. General information

NPI: 1356277057
Provider Name (Legal Business Name): NICHOLAS DAWSON PHARM D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 W QUITMAN ST
IUKA MS
38852-1132
US

IV. Provider business mailing address

1519 W QUITMAN ST
IUKA MS
38852-1132
US

V. Phone/Fax

Practice location:
  • Phone: 662-423-3629
  • Fax: 662-423-3620
Mailing address:
  • Phone: 662-423-3629
  • Fax: 662-423-3620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-010527
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: