Provider Demographics
NPI:1942582515
Name:DILLIARD, REGGIE (RPH)
Entity Type:Individual
Prefix:
First Name:REGGIE
Middle Name:
Last Name:DILLIARD
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 1:3901 HILLSBORO PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2716
Mailing Address - Country:US
Mailing Address - Phone:615-298-5340
Mailing Address - Fax:615-292-1862
Practice Address - Street 1:3901 HILLSBORO PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2716
Practice Address - Country:US
Practice Address - Phone:615-298-5340
Practice Address - Fax:615-292-1862
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3793183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist