Provider Demographics
NPI:1467094003
Name:MORRISON, LILLY
Entity Type:Individual
Prefix:
First Name:LILLY
Middle Name:
Last Name:MORRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 WILMINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:EMERALD HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:94062-4036
Mailing Address - Country:US
Mailing Address - Phone:650-257-3054
Mailing Address - Fax:
Practice Address - Street 1:920 WILMINGTON WAY
Practice Address - Street 2:
Practice Address - City:EMERALD HILLS
Practice Address - State:CA
Practice Address - Zip Code:94062-4036
Practice Address - Country:US
Practice Address - Phone:650-257-3054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist