=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134439128
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIXIE DRUGS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2010
-----------------------------------------------------
Last Update Date | 10/08/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13222 W DIXIE HWY
-----------------------------------------------------
City | NORTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33161-4133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-362-6921
-----------------------------------------------------
Fax | 786-313-3276
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13222 W DIXIE HWY
-----------------------------------------------------
City | NORTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33161-4133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-362-6921
-----------------------------------------------------
Fax | 786-313-3276
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. RAEF HAMAED
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-794-4117
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH24935
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------