Provider Demographics
NPI:1528589637
Name:DIXON, DANELLA DEONDRA
Entity Type:Individual
Prefix:DR
First Name:DANELLA
Middle Name:DEONDRA
Last Name:DIXON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 OLD BAINBRIDGE RD APT 305
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-2678
Mailing Address - Country:US
Mailing Address - Phone:850-322-8008
Mailing Address - Fax:
Practice Address - Street 1:1208 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-2126
Practice Address - Country:US
Practice Address - Phone:850-875-3021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS53805183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist