Healthcare Provider Details

I. General information

NPI: 1356987895
Provider Name (Legal Business Name): LILYANN JEU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 6TH ST
BROOKLYN NY
11215-3609
US

IV. Provider business mailing address

466 SENATOR ST
BROOKLYN NY
11220-5414
US

V. Phone/Fax

Practice location:
  • Phone: 917-747-4721
  • Fax:
Mailing address:
  • Phone: 917-658-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number048724
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number048724
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number048724
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number048724
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: