Provider Demographics
NPI:1811596950
Name:LEISURE, DILLON JAMES KENNETH (RPH)
Entity Type:Individual
Prefix:
First Name:DILLON
Middle Name:JAMES KENNETH
Last Name:LEISURE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3312 HIBERNIA PASS
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-9065
Mailing Address - Country:US
Mailing Address - Phone:513-259-7862
Mailing Address - Fax:606-663-9794
Practice Address - Street 1:179 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:KY
Practice Address - Zip Code:40380-2227
Practice Address - Country:US
Practice Address - Phone:606-663-2663
Practice Address - Fax:606-663-9794
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY020643183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist