Provider Demographics
NPI:1902220924
Name:LILA PHARMACY INC.
Entity Type:Organization
Organization Name:LILA PHARMACY INC.
Other - Org Name:CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VIKRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:520-331-7096
Mailing Address - Street 1:16137 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3374
Mailing Address - Country:US
Mailing Address - Phone:909-429-4467
Mailing Address - Fax:909-429-4743
Practice Address - Street 1:16137 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3374
Practice Address - Country:US
Practice Address - Phone:909-429-4497
Practice Address - Fax:909-429-4743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1902220924Medicaid