Provider Demographics
NPI:1770299836
Name:DILLINGHAM, CARL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:
Last Name:DILLINGHAM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 SUGAR LN APT 814
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-6179
Mailing Address - Country:US
Mailing Address - Phone:304-308-2041
Mailing Address - Fax:
Practice Address - Street 1:2223 S LOOP 256
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-4701
Practice Address - Country:US
Practice Address - Phone:903-723-0685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71091183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist