Provider Demographics
NPI:1437257177
Name:MIXSON, JENNIFER LYNN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:MIXSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4143 COBBLER DR
Mailing Address - Street 2:
Mailing Address - City:MEGGETT
Mailing Address - State:SC
Mailing Address - Zip Code:29449-6066
Mailing Address - Country:US
Mailing Address - Phone:843-889-2836
Mailing Address - Fax:
Practice Address - Street 1:109 BEE ST # 119
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-5703
Practice Address - Country:US
Practice Address - Phone:843-789-7972
Practice Address - Fax:843-805-5965
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC007452183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist