Provider Demographics
NPI:1952601957
Name:DILLENBURG, TED E JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:TED
Middle Name:E
Last Name:DILLENBURG
Suffix:JR
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 1:1555 N AURORA RD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-0705
Mailing Address - Country:US
Mailing Address - Phone:630-637-3846
Mailing Address - Fax:
Practice Address - Street 1:1555 N AURORA RD
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-0705
Practice Address - Country:US
Practice Address - Phone:630-637-3846
Practice Address - Fax:630-637-3845
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL51-031571183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist