Provider Demographics
NPI:1073398681
Name:JAMES, DILLON WESLEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:DILLON
Middle Name:WESLEY
Last Name:JAMES
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 1:7814 SE MAGGIE RD
Mailing Address - Street 2:
Mailing Address - City:POLO
Mailing Address - State:MO
Mailing Address - Zip Code:64671-9301
Mailing Address - Country:US
Mailing Address - Phone:816-605-3254
Mailing Address - Fax:
Practice Address - Street 1:1104 S 25TH ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:MO
Practice Address - Zip Code:64424-2612
Practice Address - Country:US
Practice Address - Phone:660-425-8171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022029730183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist