Provider Demographics
NPI:1487927539
Name:LILLY, JANA A
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:A
Last Name:LILLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4390 CLEARWATER WAY
Mailing Address - Street 2:APT 406
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-6359
Mailing Address - Country:US
Mailing Address - Phone:859-661-3568
Mailing Address - Fax:
Practice Address - Street 1:4390 CLEARWATER WAY
Practice Address - Street 2:APT 406
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-6359
Practice Address - Country:US
Practice Address - Phone:859-661-3568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015818183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist