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General NPI Number Information
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NPI Number | 1710294574
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Entity Type | Individual
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Provider Name | GREGORY KYLE DIXON GREGORY DIXON
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Gender | Male
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Dates
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Enumeration Date | 08/31/2010
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Last Update Date | 08/31/2010
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Provider Practice Location Address
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Address Line | 3100 GOODMAN RD W
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City | HORN LAKE
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State | MS
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Zip | 38637-1172
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Country | US
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Telephone | 662-501-0377
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Fax |
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Provider Business Mailing Address
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Address Line | 1306 HARBOR PARK DR
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City | MEMPHIS
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State | TN
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Zip | 38103-9031
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Country | US
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Telephone | 662-501-0377
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Fax |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | E-0101765
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License Number State | MS
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