Healthcare Provider Details

I. General information

NPI: 1073929188
Provider Name (Legal Business Name): TABITHA LYNNE DILLINGER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TABITHA LYNNE KNOUS PHARMD

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CORNER OF ROUTES N12 AND N7
FT. DEFIANCE AZ
86504
US

IV. Provider business mailing address

PO BOX 2521
FORT DEFIANCE AZ
86504-2521
US

V. Phone/Fax

Practice location:
  • Phone: 928-729-8328
  • Fax:
Mailing address:
  • Phone: 928-729-8328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03233800
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: