Provider Demographics
NPI:1265577266
Name:DIXON DRUG CO., INC.
Entity type:Organization
Organization Name:DIXON DRUG CO., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:REMBERT
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:843-662-5253
Mailing Address - Street 1:160 S DARGAN ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2532
Mailing Address - Country:US
Mailing Address - Phone:843-662-5253
Mailing Address - Fax:843-662-5254
Practice Address - Street 1:160 S DARGAN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2532
Practice Address - Country:US
Practice Address - Phone:843-662-5253
Practice Address - Fax:843-662-5254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50001141333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC711417Medicaid