Provider Demographics
NPI:1992760623
Name:LILLIAN PHARMACY INC
Entity type:Organization
Organization Name:LILLIAN PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:KREHLING
Authorized Official - Last Name:NOBLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-962-3777
Mailing Address - Street 1:PO BOX 59
Mailing Address - Street 2:
Mailing Address - City:LILLIAN
Mailing Address - State:AL
Mailing Address - Zip Code:36549-0059
Mailing Address - Country:US
Mailing Address - Phone:251-962-3777
Mailing Address - Fax:251-962-3779
Practice Address - Street 1:34023 US HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:LILLIAN
Practice Address - State:AL
Practice Address - Zip Code:36549-4053
Practice Address - Country:US
Practice Address - Phone:251-962-3777
Practice Address - Fax:251-962-3779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
AL3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100115465Medicaid
2123099OtherPK
AL100115465Medicaid
6354680001Medicare NSC