1669520714 NPI number — MR. JAMES MICHAEL DILLON R.P.

Table of content: MR. JAMES MICHAEL DILLON R.P. (NPI 1669520714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669520714 NPI number — MR. JAMES MICHAEL DILLON R.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DILLON
Provider First Name:
JAMES
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
R.P.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669520714
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
RR 1 BOX 1461
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STROUDSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18360-9674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-992-4062
Provider Business Mailing Address Fax Number:
610-863-3686

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
855 N BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WIND GAP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18091-1116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-863-5341
Provider Business Practice Location Address Fax Number:
610-862-3686
Provider Enumeration Date:
01/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RP027590L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RP027590L . This is a "PHARMACIST LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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