Provider Demographics
NPI:1104439314
Name:DILLON-BADER, VICTORIA LOUISE
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LOUISE
Last Name:DILLON-BADER
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 1:1191 W KANSAS ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-2281
Mailing Address - Country:US
Mailing Address - Phone:816-781-9347
Mailing Address - Fax:816-781-9492
Practice Address - Street 1:1224 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64105-1324
Practice Address - Country:US
Practice Address - Phone:417-499-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005017358183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist