Provider Demographics
NPI:1407846124
Name:DILLMAN, KRISTINA MARIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:MARIE
Last Name:DILLMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 LEE DR
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-8945
Mailing Address - Country:US
Mailing Address - Phone:717-338-9412
Mailing Address - Fax:717-359-9799
Practice Address - Street 1:520 W KING ST
Practice Address - Street 2:
Practice Address - City:LITTLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:17340-1414
Practice Address - Country:US
Practice Address - Phone:717-359-9899
Practice Address - Fax:717-359-9799
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP042982L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01821063Medicaid
PA01821063Medicaid