Provider Demographics
NPI:1316190481
Name:DIXON, DEREK EUGENE (PHARMD)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:EUGENE
Last Name:DIXON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3666 STARBURST CT
Mailing Address - Street 2:
Mailing Address - City:MULBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:33860-8526
Mailing Address - Country:US
Mailing Address - Phone:863-581-9308
Mailing Address - Fax:
Practice Address - Street 1:3666 STARBURST CT
Practice Address - Street 2:
Practice Address - City:MULBERRY
Practice Address - State:FL
Practice Address - Zip Code:33860-8526
Practice Address - Country:US
Practice Address - Phone:863-581-9308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-02
Last Update Date:2008-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38892183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist