Provider Demographics
NPI:1144840497
Name:DILLS, CARRIE
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:DILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 719
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:IA
Mailing Address - Zip Code:51537-0719
Mailing Address - Country:US
Mailing Address - Phone:712-755-2525
Mailing Address - Fax:712-755-3040
Practice Address - Street 1:2003 CHATBURN AVE
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:IA
Practice Address - Zip Code:51537-1845
Practice Address - Country:US
Practice Address - Phone:712-755-2525
Practice Address - Fax:712-755-3040
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18777183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist