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General NPI Number Information
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NPI Number | 1598890790
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Entity Type | Individual
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Provider Name | GARY LYNN HIXSON JR. CPHT
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Gender | Male
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 02/24/2012
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Provider Practice Location Address
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Address Line | 1224 GAY STREET
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City | DANDRIDGE
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State | TN
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Zip | 37725
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Country | US
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Telephone | 865-397-3444
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Fax | 865-397-6279
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Provider Business Mailing Address
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Address Line | 909 MILL ST
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City | DANDRIDGE
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State | TN
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Zip | 37725-4809
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Country | US
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Telephone | 865-705-6120
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Fax | 865-397-6279
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 17857
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License Number State | TN
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