Provider Demographics
NPI:1972596559
Name:LILLY, ROY CARROLL JR (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:CARROLL
Last Name:LILLY
Suffix:JR
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 ASHLAND PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1661
Mailing Address - Country:US
Mailing Address - Phone:718-858-7200
Mailing Address - Fax:718-246-9357
Practice Address - Street 1:265 ASHLAND PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1661
Practice Address - Country:US
Practice Address - Phone:718-858-7200
Practice Address - Fax:718-246-9357
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13083183500000X
AR8705183500000X
NYI0522361835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No183500000XPharmacy Service ProvidersPharmacist