Provider Demographics
NPI:1790299444
Name:PEDRAZA, LILLIAN DANAE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:DANAE
Last Name:PEDRAZA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LILLIAN
Other - Middle Name:DANAE
Other - Last Name:OTIENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1685 ATLANTA HWY
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30011-3636
Mailing Address - Country:US
Mailing Address - Phone:770-682-7053
Mailing Address - Fax:770-682-1566
Practice Address - Street 1:1685 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:GA
Practice Address - Zip Code:30011-3636
Practice Address - Country:US
Practice Address - Phone:770-682-7053
Practice Address - Fax:770-682-1566
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH029219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist