Provider Demographics
NPI:1740388776
Name:DIXONS PHARMACY INC
Entity Type:Organization
Organization Name:DIXONS PHARMACY INC
Other - Org Name:ADAMS CUMBERLAND PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOBIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:717-486-8606
Mailing Address - Street 1:3463 BIGLERVILLE RD
Mailing Address - Street 2:PO BOX 481
Mailing Address - City:BIGLERVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17307-9809
Mailing Address - Country:US
Mailing Address - Phone:717-677-8144
Mailing Address - Fax:717-677-9694
Practice Address - Street 1:3463 BIGLERVILLE RD
Practice Address - Street 2:
Practice Address - City:BIGLERVILLE
Practice Address - State:PA
Practice Address - Zip Code:17307-9809
Practice Address - Country:US
Practice Address - Phone:717-677-8144
Practice Address - Fax:717-677-9694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP413295L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2083994OtherPK
PA01653100Medicaid
PA01653100Medicaid