Provider Demographics
NPI:1194066480
Name:DILLMAN, LAUREN (PHARMD)
Entity type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:
Last Name:DILLMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 INDEPENDENCE ST
Mailing Address - Street 2:APARTMENT 3
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5014
Mailing Address - Country:US
Mailing Address - Phone:217-840-9726
Mailing Address - Fax:
Practice Address - Street 1:1 S KINGSHIGHWAY ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5742
Practice Address - Country:US
Practice Address - Phone:573-339-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012026232183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist