Provider Demographics
NPI:1194272823
Name:LILLARD, CRYSTAL (RPH)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:LILLARD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 W MONROE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-1438
Mailing Address - Country:US
Mailing Address - Phone:217-546-9558
Mailing Address - Fax:217-546-2582
Practice Address - Street 1:2305 W MONROE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-1438
Practice Address - Country:US
Practice Address - Phone:217-546-9558
Practice Address - Fax:217-546-2582
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-11
Last Update Date:2016-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051037808183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist