Provider Demographics
NPI:1023115714
Name:LILLY, RONALD LEROY (RPH)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:LEROY
Last Name:LILLY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BRAGG BLVD
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-2629
Mailing Address - Country:US
Mailing Address - Phone:410-674-2599
Mailing Address - Fax:410-605-7160
Practice Address - Street 1:10 N GREENE ST
Practice Address - Street 2:ATTN: PHARMACY SVC (119)
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1524
Practice Address - Country:US
Practice Address - Phone:410-605-7000
Practice Address - Fax:410-605-7160
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12950183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist