Provider Demographics
NPI:1447814330
Name:DILLARD, JUSTIN RYAN (PHARMD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:RYAN
Last Name:DILLARD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 N MAY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-2011
Mailing Address - Country:US
Mailing Address - Phone:405-943-9361
Mailing Address - Fax:405-943-9668
Practice Address - Street 1:2400 N MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-2011
Practice Address - Country:US
Practice Address - Phone:405-943-9361
Practice Address - Fax:405-943-9668
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18276183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist