Provider Demographics
NPI:1871191395
Name:DIXON, LUCINDA A (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LUCINDA
Middle Name:A
Last Name: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 1:1231 FINCH RD
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-3220
Mailing Address - Country:US
Mailing Address - Phone:770-307-8410
Mailing Address - Fax:
Practice Address - Street 1:505 DACULA RD
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-2125
Practice Address - Country:US
Practice Address - Phone:678-407-8740
Practice Address - Fax:678-407-8741
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH017218183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist