Healthcare Provider Details

I. General information

NPI: 1750689709
Provider Name (Legal Business Name): LACHERYL BRINSON CILLIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 ALLENDALE PL
MONTGOMERY AL
36111-1638
US

IV. Provider business mailing address

2300 E SOUTH BLVD
MONTGOMERY AL
36116-2504
US

V. Phone/Fax

Practice location:
  • Phone: 205-529-4441
  • Fax:
Mailing address:
  • Phone: 334-281-1312
  • Fax: 334-281-6804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11482
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: