Healthcare Provider Details

I. General information

NPI: 1720942147
Provider Name (Legal Business Name): JENNIFER KAY LILLY RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6898 N 250 W
COLUMBIA CITY IN
46725-7849
US

IV. Provider business mailing address

6898 N 250 W
COLUMBIA CITY IN
46725-7849
US

V. Phone/Fax

Practice location:
  • Phone: 260-503-9626
  • Fax:
Mailing address:
  • Phone: 260-503-9626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number26017018A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: