Provider Demographics
NPI:1992488191
Name:DABOUL, LILLIAN ADMOUN
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:ADMOUN
Last Name:DABOUL
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 1:3809 SAN BERNADO DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4608
Mailing Address - Country:US
Mailing Address - Phone:904-309-4089
Mailing Address - Fax:
Practice Address - Street 1:125 JENKINS ST
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5167
Practice Address - Country:US
Practice Address - Phone:904-810-6823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS66106183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist