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General NPI Number Information
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NPI Number | 1477184125
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Entity Type | Individual
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Provider Name | LILLIAN ATTY
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Gender | Female
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Dates
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Enumeration Date | 01/31/2020
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Last Update Date | 01/31/2020
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Provider Practice Location Address
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Address Line | 1484 RIVONA DR
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City | WATERFORD
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State | MI
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Zip | 48328
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Country | US
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Telephone | 248-505-4443
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Fax |
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Provider Business Mailing Address
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Address Line | 26026 W 12 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1783
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Country | US
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Telephone |
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Fax |
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 5302026767
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License Number State | MI
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