Provider Demographics
NPI:1093018418
Name:LILLY, AUSTIN (PHARM D RPH)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:
Last Name:LILLY
Suffix:
Gender:M
Credentials:PHARM D RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ST RT 107 BELLEPOINT
Mailing Address - Street 2:
Mailing Address - City:HINTON
Mailing Address - State:WV
Mailing Address - Zip Code:25951
Mailing Address - Country:US
Mailing Address - Phone:304-646-9846
Mailing Address - Fax:304-466-6618
Practice Address - Street 1:308 BELLEPOINT PLAZA STOKES DRIVE
Practice Address - Street 2:
Practice Address - City:HINTON
Practice Address - State:WV
Practice Address - Zip Code:25951-1111
Practice Address - Country:US
Practice Address - Phone:304-466-6615
Practice Address - Fax:304-466-6618
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0006562183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist