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General NPI Number Information
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NPI Number | 1093018418
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Entity Type | Individual
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Provider Name | AUSTIN LILLY PHARM. D. RPH.
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Gender | Male
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Dates
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Enumeration Date | 12/07/2010
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Last Update Date | 12/07/2010
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Provider Practice Location Address
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Address Line | 308 BELLEPOINT PLAZA STOKES DRIVE
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City | HINTON
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State | WV
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Zip | 25951-1111
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Country | US
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Telephone | 304-466-6615
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Fax | 304-466-6618
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Provider Business Mailing Address
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Address Line | ST RT 107 BELLEPOINT
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City | HINTON
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State | WV
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Zip | 25951
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Country | US
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Telephone | 304-646-9846
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Fax | 304-466-6618
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0006562
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License Number State | WV
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