Provider Demographics
NPI:1295761674
Name:PLAYER, JANE DIXON (RPH,CDE)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:DIXON
Last Name:PLAYER
Suffix:
Gender:F
Credentials:RPH,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 ACADEMY ST
Mailing Address - Street 2:212 ACADEMY AVENUE
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560-2102
Mailing Address - Country:US
Mailing Address - Phone:843-374-2963
Mailing Address - Fax:843-394-2551
Practice Address - Street 1:240 KELLEY ST
Practice Address - Street 2:212 ACADEMY AVENUE
Practice Address - City:LAKE CITY
Practice Address - State:SC
Practice Address - Zip Code:29560-2416
Practice Address - Country:US
Practice Address - Phone:843-374-1110
Practice Address - Fax:843-374-1117
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5201183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist