Provider Demographics
NPI:1073929188
Name:DILLINGER, TABITHA LYNNE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:LYNNE
Last Name:DILLINGER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:TABITHA
Other - Middle Name:LYNNE
Other - Last Name:KNOUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:PO BOX 2521
Mailing Address - Street 2:
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504-2521
Mailing Address - Country:US
Mailing Address - Phone:928-729-8328
Mailing Address - Fax:
Practice Address - Street 1:CORNER OF ROUTES N12 AND N7
Practice Address - Street 2:
Practice Address - City:FT. DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:928-729-8328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03233800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist