Healthcare Provider Details

I. General information

NPI: 1841885910
Provider Name (Legal Business Name): MARONDA DIXON PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BUSINESS PARK DR STE D
RIDGELAND MS
39157-6015
US

IV. Provider business mailing address

2000 PINEHAVEN DR
FLOWOOD MS
39232-8349
US

V. Phone/Fax

Practice location:
  • Phone: 601-956-6228
  • Fax:
Mailing address:
  • Phone: 601-209-9932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-09511
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: