Provider Demographics
NPI:1699099176
Name:DILDINE, THOMAS LAWSON JR (PHARM D)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:LAWSON
Last Name:DILDINE
Suffix:JR
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 NE 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-5429
Mailing Address - Country:US
Mailing Address - Phone:561-272-2124
Mailing Address - Fax:561-272-2830
Practice Address - Street 1:124 NE 5TH AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483
Practice Address - Country:US
Practice Address - Phone:561-272-2124
Practice Address - Fax:561-272-2830
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40271183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103438300Medicaid