Provider Demographics
NPI:1902402944
Name:DIXON, MATTHEW LEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:LEE
Last Name:DIXON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515A LONGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-2208
Mailing Address - Country:US
Mailing Address - Phone:540-586-3785
Mailing Address - Fax:540-586-5769
Practice Address - Street 1:1515A LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-2208
Practice Address - Country:US
Practice Address - Phone:540-586-3785
Practice Address - Fax:540-586-5769
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-06
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202214124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist