Provider Demographics
NPI:1295481844
Name:PARRISH, DYLAN MICHAEL-JAMES
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:MICHAEL-JAMES
Last Name:PARRISH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 BRONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:NEW LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45345-1203
Mailing Address - Country:US
Mailing Address - Phone:502-457-0308
Mailing Address - Fax:
Practice Address - Street 1:590 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45345-9172
Practice Address - Country:US
Practice Address - Phone:937-687-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09211295183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician