Healthcare Provider Details

I. General information

NPI: 1619250347
Provider Name (Legal Business Name): MR. JOSEPH T LILLIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 N DAVIS ST
JACKSONVILLE FL
32209-5779
US

IV. Provider business mailing address

1801 N DAVIS ST
JACKSONVILLE FL
32209-5779
US

V. Phone/Fax

Practice location:
  • Phone: 904-353-1942
  • Fax:
Mailing address:
  • Phone: 904-353-1942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS30504
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: