MEDICARE: LILY MA

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
1	183500000X	Pharmacist	50742	CA

General Provider Information

NPI Number	:	1538647771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILY MA

Provider Business Mailing Address
First Line	:	1240 E YORBA LINDA BLVD
Second Line	:
City	:	PLACENTIA
State	:	CA
Zip	:	92870-3832
Country	:	US
Telephone Number	:	714-996-7050
Fax Number	:

Provider Business Practice Location Address
First Line	:	1240 E YORBA LINDA BLVD
Second Line	:
City	:	PLACENTIA
State	:	CA
Zip	:	92870-3832
Country	:	US
Telephone Number	:	714-996-7050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2018
Last Update Date	:	07/31/2018

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Directions to “ LILY MA ” Practice Location

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