Provider Demographics
NPI:1619260536
Name:LOH, LILY MK (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:MK
Last Name:LOH
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 1:12080 SW MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6218
Mailing Address - Country:US
Mailing Address - Phone:503-620-9322
Mailing Address - Fax:503-620-0638
Practice Address - Street 1:12080 SW MAIN ST
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6218
Practice Address - Country:US
Practice Address - Phone:503-620-9322
Practice Address - Fax:503-620-0638
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist