Healthcare Provider Details

I. General information

NPI: 1578898219
Provider Name (Legal Business Name): CAROL LILLY-REYNOLDS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 GARDNER DR
WILMINGTON NC
28405-8873
US

IV. Provider business mailing address

1317 HAWTHORNE RD
WILMINGTON NC
28403-4005
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-5300
  • Fax:
Mailing address:
  • Phone: 337-936-9880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5998
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: