Healthcare Provider Details

I. General information

NPI: 1306649751
Provider Name (Legal Business Name): LILY JOUBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 ELLIOTT ST
BEVERLY MA
01915-3359
US

IV. Provider business mailing address

54 ELLIOTT ST
BEVERLY MA
01915-3359
US

V. Phone/Fax

Practice location:
  • Phone: 978-921-0506
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH1001629
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: