Provider Demographics
NPI:1891252805
Name:DIXON, ALVIN CLAYTON
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:CLAYTON
Last Name:DIXON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-4121
Mailing Address - Country:US
Mailing Address - Phone:662-934-9213
Mailing Address - Fax:
Practice Address - Street 1:1967 HOSPITAL DR STE B
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-7203
Practice Address - Country:US
Practice Address - Phone:662-624-5481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-07820183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist