NPIMap

Organization Active NPI

Dillon Companies LLC

Doing business as King Soopers Pharmacy #112

  • Community/Retail Pharmacy
  • Bennett, CO
National Provider Identifier
1710179296
Registry record updated Apr 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
698 Issued in CO
Legal business name
DILLON COMPANIES LLC
Doing business as
King Soopers Pharmacy #112
Practice address
1045 S 1St St
Bennett, CO 80102
Phone
(303) 644-5080
Fax
(303) 647-4242
NPI assigned
Aug 17, 2007
Last updated
Apr 22, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jessie Warman
Title
Manager of Pharmacy Licensing
Phone
(513) 762-1019

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 698 CO Primary

Addresses

Primary practice location

1045 S 1St St
Bennett, CO 80102

Mailing address

PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019

Other names 1

  • KING SOOPERS PHARMACY #112 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040902001249 CO Part B Supplier - Mass Immunization (Roster Biller Only) 5890690135 This NPI is an additional NPI on the enrollment
O20100930066845 CO DME Supplier - Pharmacy 5890690135 Practice locations: Bennett, CO

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D2017548King Soopers #1121045 S 1St St, Bennett, CO 80102Certificate of waiverDec 12, 2026

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
King Soopers Pharmacy1045 S 1St St, Bennett, CO 80102-7912(303) 644-5080 Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Walkers|Ostomy Supplies|Urological Supplies|Enteral Nutrients|Enteral Equipment and/or Supplies|Nebulizer Equipment a… Accepts assignmentParticipating since Oct 1, 2007

National Provider Directory

National Provider Directory
Tax ID family
Kroger240 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745280000000",
    "number": "1710179296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 842772",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022842772",
            "telephone_number": "513-762-1019",
            "fax_number": "513-762-1092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 S 1ST ST",
            "city": "BENNETT",
            "state": "CO",
            "postal_code": "80102",
            "telephone_number": "303-644-5080",
            "fax_number": "303-647-4242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DILLON COMPANIES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-17",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A",
        "authorized_official_last_name": "WARMAN",
        "authorized_official_first_name": "JESSIE",
        "authorized_official_title_or_position": "MANAGER OF PHARMACY LICENSING",
        "authorized_official_telephone_number": "513-762-1019"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CO",
            "license": "698",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KING SOOPERS PHARMACY #112",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "KING SOOPERS PHARMACY #112",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bennett, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.