Provider Demographics
NPI:1538892575
Name:ABHOLD, DILLON NORBERT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DILLON
Middle Name:NORBERT
Last Name:ABHOLD
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:N4686 SHEEHAN LAKE LN
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSPORT
Mailing Address - State:WI
Mailing Address - Zip Code:53010-1451
Mailing Address - Country:US
Mailing Address - Phone:920-904-7633
Mailing Address - Fax:
Practice Address - Street 1:2455 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:WI
Practice Address - Zip Code:53073-4240
Practice Address - Country:US
Practice Address - Phone:920-893-5895
Practice Address - Fax:920-893-5898
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21278-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist