Provider Demographics
NPI:1316664675
Name:DE JESUS, LILLIAM (RPH)
Entity type:Individual
Prefix:
First Name:LILLIAM
Middle Name:
Last Name:DE JESUS
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:PO BOX 581
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0581
Mailing Address - Country:US
Mailing Address - Phone:787-843-1838
Mailing Address - Fax:787-284-0838
Practice Address - Street 1:FARMACIA LORRAINE
Practice Address - Street 2:1681 PASEO VILLA FLORES
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2953
Practice Address - Country:US
Practice Address - Phone:787-843-1838
Practice Address - Fax:787-284-0838
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3628183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist