Healthcare Provider Details

I. General information

NPI: 1124937669
Provider Name (Legal Business Name): LILY MADISON COUTU PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 TROTWOOD AVE
COLUMBIA TN
38401-4802
US

IV. Provider business mailing address

2600 NAPA VALLEY WAY APT F136
COLUMBIA TN
38401-5186
US

V. Phone/Fax

Practice location:
  • Phone: 931-381-1111
  • Fax:
Mailing address:
  • Phone: 978-995-6556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number50042
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: