Provider Demographics
NPI:1649615592
Name:DIXON, WOODROW (PHARMD)
Entity type:Individual
Prefix:
First Name:WOODROW
Middle Name:
Last Name:DIXON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4460 RODGERS RD E
Mailing Address - Street 2:
Mailing Address - City:RISON
Mailing Address - State:AR
Mailing Address - Zip Code:71665-9139
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:908 W 4TH ST
Practice Address - Street 2:
Practice Address - City:FORDYCE
Practice Address - State:AR
Practice Address - Zip Code:71742-2216
Practice Address - Country:US
Practice Address - Phone:870-352-2161
Practice Address - Fax:870-352-3236
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD09191183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist