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Organization

DIXIE INFUSION PHARMACY, LLC

Active
Other names
Dixie Vital Care - AIC
Organization subpart
No

Provider details

NPI number
Authorized official
NAVAS SOFIA YOONUS-KUNJU (OWNER)
(615) 525-3142
Entity
Organization

Contact information

Practice address
311 LANDRUM PL STE 600, CLARKSVILLE, TN 37043-6319
(931) 241-5655
(931) 241-5654
Mailing address
311 LANDRUM PL STE 600, CLARKSVILLE, TN 37043-6319
(931) 241-5655
(931) 241-5654

Taxonomy

Speciality
Code
Description
License number
State
261QI0500X
Infusion Therapy Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
103G700425
LOCAL MEDICARE - PART B
TN
Enumeration date
09/21/2018
Last updated
09/21/2018
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