Healthcare Provider Details

I. General information

NPI: 1740118207
Provider Name (Legal Business Name): KERI TILLMAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9245 W WHITE FEATHER LN
PEORIA AZ
85383-5486
US

IV. Provider business mailing address

9245 W WHITE FEATHER LN
PEORIA AZ
85383-5486
US

V. Phone/Fax

Practice location:
  • Phone: 623-203-3460
  • Fax:
Mailing address:
  • Phone: 623-203-3460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS016830
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: