Provider Demographics
NPI:1154829547
Name:TILLMAN, CECELIA (RPH)
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11306 MITSCHER ST
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1330
Mailing Address - Country:US
Mailing Address - Phone:240-441-0670
Mailing Address - Fax:
Practice Address - Street 1:11306 MITSCHER ST
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-1330
Practice Address - Country:US
Practice Address - Phone:240-441-0670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00853183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD00000OtherNONE