Provider Demographics
NPI:1710294574
Name:DIXON, GREGORY KYLE (GREGORY DIXON)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:KYLE
Last Name:DIXON
Suffix:
Gender:M
Credentials:GREGORY DIXON
Other - Prefix:MR
Other - First Name:GREGORY
Other - Middle Name:KYLE
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:1306 HARBOR PARK DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-9031
Mailing Address - Country:US
Mailing Address - Phone:662-501-0377
Mailing Address - Fax:
Practice Address - Street 1:3100 GOODMAN RD W
Practice Address - Street 2:
Practice Address - City:HORN LAKE
Practice Address - State:MS
Practice Address - Zip Code:38637-1172
Practice Address - Country:US
Practice Address - Phone:662-501-0377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-0101765183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist