Provider Demographics
NPI:1306547955
Name:YAMAMOTO, LILY (PHARMD)
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:
Last Name:YAMAMOTO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 PACIFIC ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2429
Mailing Address - Country:US
Mailing Address - Phone:310-528-1022
Mailing Address - Fax:
Practice Address - Street 1:650 PACIFIC ST UNIT 3
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-2429
Practice Address - Country:US
Practice Address - Phone:310-528-1022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38958183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist