Healthcare Provider Details

I. General information

NPI: 1326974064
Provider Name (Legal Business Name): GRAYSON RECE DILLON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1058 TANGLEWOOD DR
FRANKLINTON LA
70438-5673
US

IV. Provider business mailing address

381 GINNTOWN RD
TYLERTOWN MS
39667-5606
US

V. Phone/Fax

Practice location:
  • Phone: 985-839-7200
  • Fax:
Mailing address:
  • Phone: 601-876-7244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.026271
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: