Provider Demographics
NPI:1942594569
Name:DIXON, WILLIAM BARNETT JR (R PH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:BARNETT
Last Name:DIXON
Suffix:JR
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 PROVIDENCE RD S
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-8314
Mailing Address - Country:US
Mailing Address - Phone:704-243-3777
Mailing Address - Fax:704-843-3641
Practice Address - Street 1:1602 PROVIDENCE RD S
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-8314
Practice Address - Country:US
Practice Address - Phone:704-243-3777
Practice Address - Fax:704-843-3641
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9671183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist