Provider Demographics
NPI:1689827396
Name:DILLON, JENNIFER MICHELE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MICHELE
Last Name:DILLON
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 1:401 W SENECA TPKE STE 1
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13207-2644
Mailing Address - Country:US
Mailing Address - Phone:315-492-4034
Mailing Address - Fax:315-492-3103
Practice Address - Street 1:596 ROUTE 11
Practice Address - Street 2:
Practice Address - City:TULLY
Practice Address - State:NY
Practice Address - Zip Code:13159
Practice Address - Country:US
Practice Address - Phone:315-696-8796
Practice Address - Fax:315-696-6145
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-25
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049610-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist