Provider Demographics
NPI:1508134719
Name:DIXON, JOHN RICHARD I (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:RICHARD
Last Name:DIXON
Suffix:I
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:RICHARD
Other - Last Name:DIXON
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:729 NO. H ST.
Mailing Address - Street 2:VONS
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-7923
Mailing Address - Country:US
Mailing Address - Phone:805-735-4388
Mailing Address - Fax:805-735-4721
Practice Address - Street 1:729 NO. H ST.
Practice Address - Street 2:VONS
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7923
Practice Address - Country:US
Practice Address - Phone:805-735-4388
Practice Address - Fax:805-735-4721
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 25239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist