Provider Demographics
NPI:1417460189
Name:DIXON, MELVIN ALEX III (PHARM D)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:ALEX
Last Name:DIXON
Suffix:III
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2543 PINEY GROVE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:GA
Mailing Address - Zip Code:31518-4008
Mailing Address - Country:US
Mailing Address - Phone:912-310-0700
Mailing Address - Fax:
Practice Address - Street 1:700 E DERENNE AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6716
Practice Address - Country:US
Practice Address - Phone:912-354-4853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH030303183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist