Provider Demographics
NPI:1962658088
Name:DIXON, NICOLE MARGARET (RPH)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARGARET
Last Name:DIXON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 BLAIR ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-2445
Mailing Address - Country:US
Mailing Address - Phone:814-696-0289
Mailing Address - Fax:
Practice Address - Street 1:1256 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:PA
Practice Address - Zip Code:16686-1618
Practice Address - Country:US
Practice Address - Phone:814-684-0230
Practice Address - Fax:814-684-0845
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP18918512183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist