Provider Demographics
NPI:1518210616
Name:NIXON, JIM
Entity Type:Individual
Prefix:MR
First Name:JIM
Middle Name:
Last Name:NIXON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 EASTSIDE RD
Mailing Address - Street 2:APT # 1
Mailing Address - City:NORTH CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03860
Mailing Address - Country:US
Mailing Address - Phone:603-539-8780
Mailing Address - Fax:603-539-8824
Practice Address - Street 1:244 HIGH WATCH RD
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:NH
Practice Address - Zip Code:03882-8336
Practice Address - Country:US
Practice Address - Phone:603-539-8780
Practice Address - Fax:603-539-8824
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR953183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHR953OtherPHARMACY LICENSE