Provider Demographics
NPI:1780024679
Name:DIXIE INDEPENDENT ENTERPRISES, LLC
Entity Type:Organization
Organization Name:DIXIE INDEPENDENT ENTERPRISES, LLC
Other - Org Name:ANDERSON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWER
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARGO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:205-589-6557
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:AL
Mailing Address - Zip Code:35952
Mailing Address - Country:US
Mailing Address - Phone:205-589-6557
Mailing Address - Fax:205-589-6553
Practice Address - Street 1:7101 ETOWAH ST
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:AL
Practice Address - Zip Code:35952
Practice Address - Country:US
Practice Address - Phone:205-589-6557
Practice Address - Fax:205-589-6553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
183500000X, 333600000X
AL101165333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100001368Medicaid