Healthcare Provider Details

I. General information

NPI: 1073398681
Provider Name (Legal Business Name): DILLON WESLEY JAMES PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 S 25TH ST
BETHANY MO
64424-2612
US

IV. Provider business mailing address

7814 SE MAGGIE RD
POLO MO
64671-9301
US

V. Phone/Fax

Practice location:
  • Phone: 660-425-8171
  • Fax:
Mailing address:
  • Phone: 816-605-3254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2022029730
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: