Provider Demographics
NPI:1639775877
Name:BURRELL, LILLIAN
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:BURRELL
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 1:501 ROUTE 9 STE 100
Mailing Address - Street 2:
Mailing Address - City:WARETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08758-1751
Mailing Address - Country:US
Mailing Address - Phone:609-971-6002
Mailing Address - Fax:609-971-0257
Practice Address - Street 1:501 ROUTE 9
Practice Address - Street 2:
Practice Address - City:WARETOWN
Practice Address - State:NJ
Practice Address - Zip Code:08758-1743
Practice Address - Country:US
Practice Address - Phone:609-971-6002
Practice Address - Fax:609-971-0257
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02411000183500000X
NJ28RIO2411000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist