Healthcare Provider Details

I. General information

NPI: 1295491454
Provider Name (Legal Business Name): LILY RUAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 WALKER ST
NEW YORK NY
10013-4108
US

IV. Provider business mailing address

92 BAXTER ST
NEW YORK NY
10013-4407
US

V. Phone/Fax

Practice location:
  • Phone: 212-219-8668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number068519
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: