MEDICARE: DILLARD MEDICAL INS 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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1457208175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DILLARD MEDICAL INS LLC

Provider Business Mailing Address
First Line	:	5090 RICHMOND AVE UNIT 315
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-7402
Country	:	US
Telephone Number	:	409-232-7124
Fax Number	:

Provider Business Practice Location Address
First Line	:	2637 MARILEE LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-4205
Country	:	US
Telephone Number	:	409-232-7124
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	ADREONNA A DILLARD
Credential	:
Telephone Number	:	409-232-7124

Provider Enumeration Date	:	03/12/2026
Last Update Date	:	03/12/2026

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Directions to “DILLARD MEDICAL INS LLC ” Practice Location

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