Provider Demographics
NPI:1982904397
Name:DILLON, JOHN ELLSWORTH (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ELLSWORTH
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 1:8010 E SANTA ANA CANYON RD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1110
Mailing Address - Country:US
Mailing Address - Phone:714-282-7056
Mailing Address - Fax:714-282-7407
Practice Address - Street 1:8010 E SANTA ANA CANYON RD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-1110
Practice Address - Country:US
Practice Address - Phone:714-282-7056
Practice Address - Fax:714-282-7407
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist