Provider Demographics
NPI:1669730594
Name:DILLON, SHAUN C (RPH)
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:C
Last Name:DILLON
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 1:430 SE 192ND AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9531
Mailing Address - Country:US
Mailing Address - Phone:503-349-6644
Mailing Address - Fax:888-452-8127
Practice Address - Street 1:13 NW 23RD PL
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3534
Practice Address - Country:US
Practice Address - Phone:503-226-6211
Practice Address - Fax:503-226-5390
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-28
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-00093071835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist