Healthcare Provider Details

I. General information

NPI: 1609052638
Provider Name (Legal Business Name): LILIAN BEJARANO RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8911 NORTHERN BLVD
JACKSON HEIGHTS NY
11372-1674
US

IV. Provider business mailing address

19312 39TH AVE
FLUSHING NY
11358-4020
US

V. Phone/Fax

Practice location:
  • Phone: 718-426-2508
  • Fax:
Mailing address:
  • Phone: 718-640-7024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number049077
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: