Provider Demographics
NPI:1992495709
Name:LILLIE, CYRILLA DAWN (PHARMACY TECHNICIAN)
Entity type:Individual
Prefix:
First Name:CYRILLA
Middle Name:DAWN
Last Name:LILLIE
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 US HIGHWAY 31 S
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-8038
Mailing Address - Country:US
Mailing Address - Phone:231-943-9288
Mailing Address - Fax:231-943-8747
Practice Address - Street 1:939 US HIGHWAY 31 S
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49685-8038
Practice Address - Country:US
Practice Address - Phone:231-943-9288
Practice Address - Fax:231-943-8747
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303012059183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician