=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710179296
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DILLON COMPANIES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2007
-----------------------------------------------------
Last Update Date | 04/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1045 S 1ST ST
-----------------------------------------------------
City | BENNETT
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-644-5080
-----------------------------------------------------
Fax | 303-647-4242
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 842772
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02284-2772
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-762-1019
-----------------------------------------------------
Fax | 513-762-1092
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER OF PHARMACY LICENSING
-----------------------------------------------------
Name | JESSIE WARMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 513-762-1019
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 698
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------