Provider Demographics
NPI:1104164086
Name:DIXON, STEPHEN CRAIG (DC,RPH)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CRAIG
Last Name:DIXON
Suffix:
Gender:M
Credentials:DC,RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1453 AMBASSADOR DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-2521
Mailing Address - Country:US
Mailing Address - Phone:727-515-3356
Mailing Address - Fax:
Practice Address - Street 1:4701 PARK BLVD N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3533
Practice Address - Country:US
Practice Address - Phone:727-546-4890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS20269183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist