Provider Demographics
NPI:1093006124
Name:DIXON, ERNEST D (RPH)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:D
Last Name:DIXON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43828 CHURCHILL GLEN DR
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-5769
Mailing Address - Country:US
Mailing Address - Phone:703-901-6503
Mailing Address - Fax:703-266-3361
Practice Address - Street 1:4080 LAFAYETTE CENTER DR
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1247
Practice Address - Country:US
Practice Address - Phone:703-266-3667
Practice Address - Fax:703-266-3361
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-24
Last Update Date:2011-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009713183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist