Provider Demographics
NPI:1073771929
Name:LILL, JEANNE A (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:A
Last Name:LILL
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 RIDGE RD EAST
Mailing Address - Street 2:WEGMANS PHARMACY
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14622
Mailing Address - Country:US
Mailing Address - Phone:585-544-8552
Mailing Address - Fax:585-342-8487
Practice Address - Street 1:2200 RIDGE RD EAST
Practice Address - Street 2:WEGMANS PHARMACY
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14622
Practice Address - Country:US
Practice Address - Phone:585-544-8552
Practice Address - Fax:585-342-8487
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029784183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist