Provider Demographics
NPI:1629681770
Name:DUNDIY, LILIYA ALEKSANDROVNA
Entity Type:Individual
Prefix:
First Name:LILIYA
Middle Name:ALEKSANDROVNA
Last Name:DUNDIY
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 1:6742 FLAGCREST DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-8339
Mailing Address - Country:US
Mailing Address - Phone:423-762-5620
Mailing Address - Fax:
Practice Address - Street 1:3508 RINGGOLD RD
Practice Address - Street 2:
Practice Address - City:EAST RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37412-1208
Practice Address - Country:US
Practice Address - Phone:423-624-6854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43694183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist