Provider Demographics
NPI:1386905594
Name:PEACOCK, LILY L (RPH)
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:L
Last Name:PEACOCK
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 1:23475 NE NOVELTY HILL RD
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-5501
Mailing Address - Country:US
Mailing Address - Phone:425-636-0440
Mailing Address - Fax:
Practice Address - Street 1:23475 NE NOVELTY HILL RD
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-5501
Practice Address - Country:US
Practice Address - Phone:425-636-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00071668183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist