MEDICARE: DILLON COMPANIES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	3336C0003X	Community/Retail Pharmacy	440000052	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2003254	OTHER		PK

General Provider Information

NPI Number	:	1134164809
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DILLON COMPANIES LLC

Provider Business Mailing Address
First Line	:	PO BOX 842772
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02284-2772
Country	:	US
Telephone Number	:	513-762-1019
Fax Number	:	513-762-1092

Provider Business Practice Location Address
First Line	:	4503 JOHN F KENNEDY PKWY
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525
Country	:	US
Telephone Number	:	970-223-5769
Fax Number	:	970-223-5844

Authorized Official
Title or Position	:	MANAGER OF PHARMACY LICENSING
Name	:	JESSIE WARMAN
Credential	:
Telephone Number	:	513-762-1019

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	08/06/2018

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