MEDICARE: ROBERT SCOTT LILLIEN

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	183700000X	Pharmacy Technician	RPT12772	FL

General Provider Information

NPI Number	:	1659647634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT SCOTT LILLIEN

Provider Business Mailing Address
First Line	:	6429 GALL BLVD
Second Line	:
City	:	ZEPHYRHILLS
State	:	FL
Zip	:	33542-2570
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6429 GALL BLVD
Second Line	:
City	:	ZEPHYRHILLS
State	:	FL
Zip	:	33542-2570
Country	:	US
Telephone Number	:	813-782-9571
Fax Number	:

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

Provider Enumeration Date	:	03/24/2012
Last Update Date	:	03/24/2012

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