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General NPI Number Information
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NPI Number | 1750702270
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Entity Type | Individual
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Provider Name | JOHN TILLEY
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Gender | Male
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Dates
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Enumeration Date | 12/31/2013
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Last Update Date | 12/31/2013
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Provider Practice Location Address
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Address Line | 11411 BROOKSHIRE AVE SUITE #107
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City | DOWNEY
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State | CA
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Zip | 90241-5026
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Country | US
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Telephone | 562-923-1256
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Fax | 562-923-1847
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Provider Business Mailing Address
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Address Line | 11411 BROOKSHIRE AVE SUITE #107
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City | DOWNEY
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State | CA
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Zip | 90241-5026
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Country | US
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Telephone | 562-923-1256
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Fax | 562-923-1847
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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 | RPH31351
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | RPH31351
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License Number State | CA
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