Provider Demographics
NPI:1841402294
Name:LILLY, RONALD F (BSPHARM,RPH, PD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:F
Last Name:LILLY
Suffix:
Gender:M
Credentials:BSPHARM,RPH, PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1186 DRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2156
Mailing Address - Country:US
Mailing Address - Phone:304-253-4885
Mailing Address - Fax:
Practice Address - Street 1:430 MAIN ST W
Practice Address - Street 2:PLATEAU MEDICAL CENTER PHARMACY
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-3414
Practice Address - Country:US
Practice Address - Phone:304-465-5785
Practice Address - Fax:304-929-2465
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist