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NPI Code Detail

MEDICARE: LILLIAN PORTILLO RPH

MEDICARE: LILLIAN PORTILLO RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistRPH031494GA

General Provider Information

NPI Number : 1396398269
Entity Type Code : Individual
Provider Name (Legal Business Name) : LILLIAN PORTILLO RPH
Provider Business Mailing Address
First Line : 588 MARTHA SUE DRIVE
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30045
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 930 NEW HOPE RD
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30045-6407
Country : US
Telephone Number : 770-682-2433
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2019
Last Update Date : 07/19/2019

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