Provider Demographics
NPI:1376820837
Name:DILLARD, KAREN WALKER
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:WALKER
Last Name:DILLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 S GLOSTER ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6312
Mailing Address - Country:US
Mailing Address - Phone:662-844-1318
Mailing Address - Fax:662-840-1408
Practice Address - Street 1:902 S GLOSTER ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6312
Practice Address - Country:US
Practice Address - Phone:662-844-1318
Practice Address - Fax:662-840-1408
Is Sole Proprietor?:No
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-07644183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist