MEDICARE: LEAH TILLAS

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	333600000X	Pharmacy

General Provider Information

NPI Number	:	1841887528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH TILLAS

Provider Business Mailing Address
First Line	:	1801 CONGRESS AVE
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-1320
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 CONGRESS AVE
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-1320
Country	:	US
Telephone Number	:	999-999-9999
Fax Number	:

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

Provider Enumeration Date	:	12/28/2020
Last Update Date	:	09/03/2025

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Directions to “ LEAH TILLAS ” Practice Location

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