Provider Demographics
NPI:1669520714
Name:DILLON, JAMES MICHAEL (RP)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MICHAEL
Last Name:DILLON
Suffix:
Gender:M
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 1461
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-9674
Mailing Address - Country:US
Mailing Address - Phone:570-992-4062
Mailing Address - Fax:610-863-3686
Practice Address - Street 1:855 N BROADWAY
Practice Address - Street 2:
Practice Address - City:WIND GAP
Practice Address - State:PA
Practice Address - Zip Code:18091-1116
Practice Address - Country:US
Practice Address - Phone:610-863-5341
Practice Address - Fax:610-862-3686
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP027590L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP027590LOtherPHARMACIST LICENSE