Healthcare Provider Details

I. General information

NPI: 1568585941
Provider Name (Legal Business Name): WILLIAM A MIXON R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 4TH ST SW
HICKORY NC
28602-3401
US

IV. Provider business mailing address

750 4TH ST SW
HICKORY NC
28602-3401
US

V. Phone/Fax

Practice location:
  • Phone: 828-322-9365
  • Fax:
Mailing address:
  • Phone: 828-322-9365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number07723
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: