=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073198537
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOTSON HOLDINGS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2021
-----------------------------------------------------
Last Update Date | 09/30/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16 WILLIAM POPE DR STE 201
-----------------------------------------------------
City | BLUFFTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29909-7504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-770-7707
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 121
-----------------------------------------------------
City | GRAYSON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41143-0121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-255-3154
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JACOB DOTSON
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 606-255-3154
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------