Provider Demographics
NPI:1912502865
Name:DILLARD, JONATHAN
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:DILLARD
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 1:1032 FOUNDERS LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37148-5163
Mailing Address - Country:US
Mailing Address - Phone:270-776-4897
Mailing Address - Fax:
Practice Address - Street 1:925 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:KY
Practice Address - Zip Code:42134-2359
Practice Address - Country:US
Practice Address - Phone:270-586-0787
Practice Address - Fax:270-586-8950
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42203183500000X
KY020167183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist