Provider Demographics
NPI:1073198537
Name:DOTSON HOLDINGS LLC
Entity Type:Organization
Organization Name:DOTSON HOLDINGS LLC
Other - Org Name:BEAUFORT DRUG COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:DOTSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:606-255-3154
Mailing Address - Street 1:PO BOX 121
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-0121
Mailing Address - Country:US
Mailing Address - Phone:606-255-3154
Mailing Address - Fax:
Practice Address - Street 1:16 WILLIAM POPE DR STE 201
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29909-7504
Practice Address - Country:US
Practice Address - Phone:843-770-7707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-16
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC20062OtherBOP