Healthcare Provider Details

I. General information

NPI: 1467317032
Provider Name (Legal Business Name): DEREK MIXON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARKLAND DR
DERRY NH
03038-2746
US

IV. Provider business mailing address

8 MOCCASIN PATH
ATKINSON NH
03811-2361
US

V. Phone/Fax

Practice location:
  • Phone: 603-432-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH233955
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: