Provider Demographics
NPI:1568922847
Name:MIXON DRUG COMPANY, LLC
Entity Type:Organization
Organization Name:MIXON DRUG COMPANY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:MIXON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:601-832-8601
Mailing Address - Street 1:1220 23RD ST
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-3216
Mailing Address - Country:US
Mailing Address - Phone:601-832-8601
Mailing Address - Fax:228-864-2402
Practice Address - Street 1:12372 HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-2741
Practice Address - Country:US
Practice Address - Phone:228-832-1414
Practice Address - Fax:228-832-1471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy