Provider Demographics
NPI:1699540948
Name:BRIGHT, LILIANA
Entity type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:BRIGHT
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 1:11215 TYRONE TRL
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-4022
Mailing Address - Country:US
Mailing Address - Phone:810-919-4146
Mailing Address - Fax:
Practice Address - Street 1:50496 PONTIAC TRL STE 1500
Practice Address - Street 2:
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393-2088
Practice Address - Country:US
Practice Address - Phone:888-611-2941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302030193183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist