MEDICARE: LILY LIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	26027810A	IN

General Provider Information

NPI Number	:	1740878107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILY LIN

Provider Business Mailing Address
First Line	:	6120 ROBBINS RD
Second Line	:
City	:	PORTAGE
State	:	IN
Zip	:	46368-4400
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3253 FRANKLIN ST
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-7005
Country	:	US
Telephone Number	:	646-520-8939
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/01/2021
Last Update Date	:	01/01/2021

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Directions to “ LILY LIN ” Practice Location

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