Provider Demographics
NPI:1164463501
Name:DILLON COMPANIES LLC
Entity Type:Organization
Organization Name:DILLON COMPANIES LLC
Other - Org Name:DILLON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER RX LICENSING
Authorized Official - Prefix:
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-762-1019
Mailing Address - Street 1:2700 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67501-1903
Mailing Address - Country:US
Mailing Address - Phone:620-665-5511
Mailing Address - Fax:620-669-1894
Practice Address - Street 1:2843 E SUNSHINE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804
Practice Address - Country:US
Practice Address - Phone:417-227-1000
Practice Address - Fax:417-227-1104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
MO36843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600120141Medicaid
2049860OtherPK
MO600120141Medicaid
MA1988Medicare PIN