MEDICARE: DR. LILY MARIE REBMANN PHARMD.

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	051-292477	IL
2	1835P1200X	Pharmacotherapy Pharmacist	051-292477	IL

General Provider Information

NPI Number	:	1801043310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LILY MARIE REBMANN PHARMD.

Provider Business Mailing Address
First Line	:	3025 E NEW YORK ST
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-5166
Country	:	US
Telephone Number	:	630-236-0847
Fax Number	:

Provider Business Practice Location Address
First Line	:	3025 E NEW YORK ST
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-5166
Country	:	US
Telephone Number	:	630-236-0847
Fax Number	:

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

Provider Enumeration Date	:	08/26/2008
Last Update Date	:	08/26/2008

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