Healthcare Provider Details

I. General information

NPI: 1093007940
Provider Name (Legal Business Name): SEAN DILLON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 05/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N MAIN AVE
SCRANTON PA
18504-1866
US

IV. Provider business mailing address

8 COLONIAL RD
DALLAS PA
18612-1703
US

V. Phone/Fax

Practice location:
  • Phone: 570-342-6411
  • Fax:
Mailing address:
  • Phone: 570-472-2901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP044246L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: