Provider Demographics
NPI:1982964599
Name:ANGLIN-DIXON, JACQUELINE E (PHARMD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:E
Last Name:ANGLIN-DIXON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BEECH TREE WAY
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06461-1877
Mailing Address - Country:US
Mailing Address - Phone:203-713-6547
Mailing Address - Fax:
Practice Address - Street 1:900 NORTHROP RD
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-1997
Practice Address - Country:US
Practice Address - Phone:877-274-7871
Practice Address - Fax:877-847-9904
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT 00077871835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTPCT.0007787OtherSTATE OF CONNECTICUT