Healthcare Provider Details

I. General information

NPI: 1073771929
Provider Name (Legal Business Name): JEANNE A LILL PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 RIDGE RD EAST WEGMANS PHARMACY
ROCHESTER NY
14622
US

IV. Provider business mailing address

2200 RIDGE RD EAST WEGMANS PHARMACY
ROCHESTER NY
14622
US

V. Phone/Fax

Practice location:
  • Phone: 585-544-8552
  • Fax: 585-342-8487
Mailing address:
  • Phone: 585-544-8552
  • Fax: 585-342-8487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number029784
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: