Provider Demographics
NPI:1235868613
Name:DIX, JACKIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:
Last Name:DIX
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2833 MCCAMMON RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:TN
Mailing Address - Zip Code:37853-4019
Mailing Address - Country:US
Mailing Address - Phone:602-819-1063
Mailing Address - Fax:
Practice Address - Street 1:401 E JACKSON ST STE 3300
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-5228
Practice Address - Country:US
Practice Address - Phone:866-277-3679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33961183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist