Provider Demographics
NPI:1447765623
Name:JAMES, LILLITH
Entity Type:Individual
Prefix:
First Name:LILLITH
Middle Name:
Last Name:JAMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LILLITH
Other - Middle Name:
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:222 OLIVER AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-2823
Mailing Address - Country:US
Mailing Address - Phone:609-638-9091
Mailing Address - Fax:
Practice Address - Street 1:359 PENNINGTON AVE STE 8
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-3615
Practice Address - Country:US
Practice Address - Phone:609-571-9820
Practice Address - Fax:609-571-9822
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-09
Last Update Date:2017-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02537900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI02537900OtherPHARMACY LICENCE