Provider Demographics
NPI:1770178238
Name:MIXON, JAMES ADAM (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ADAM
Last Name:MIXON
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 1:4300 15TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2524
Mailing Address - Country:US
Mailing Address - Phone:228-864-3514
Mailing Address - Fax:228-864-2402
Practice Address - Street 1:4300 15TH ST STE 1
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2524
Practice Address - Country:US
Practice Address - Phone:228-864-3514
Practice Address - Fax:228-864-2402
Is Sole Proprietor?:No
Enumeration Date:2021-03-06
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE010072183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist