Provider Demographics
NPI:1336422153
Name:NIXON-MARCELLE, DENISE (RPH)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:NIXON-MARCELLE
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 1:1001 N DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-2170
Mailing Address - Country:US
Mailing Address - Phone:561-582-0070
Mailing Address - Fax:561-582-9235
Practice Address - Street 1:1001 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-2170
Practice Address - Country:US
Practice Address - Phone:561-582-0070
Practice Address - Fax:561-582-9235
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL34082183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist