Provider Demographics
NPI:1922610047
Name:OSTRANDER, LILLIAN CHARLOTTE
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:CHARLOTTE
Last Name:OSTRANDER
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 1:720 RIVERSIDE DR APT 217
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43605-5604
Mailing Address - Country:US
Mailing Address - Phone:440-520-5488
Mailing Address - Fax:
Practice Address - Street 1:5033 SUDER AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43611-1487
Practice Address - Country:US
Practice Address - Phone:419-729-9934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03440121183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist