Provider Demographics
NPI:1669869376
Name:LILY CARE LLC
Entity type:Organization
Organization Name:LILY CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:DU PHUONG
Authorized Official - Middle Name:THI
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:727-233-9908
Mailing Address - Street 1:11060 LYNN LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-5641
Mailing Address - Country:US
Mailing Address - Phone:727-233-9908
Mailing Address - Fax:727-233-9910
Practice Address - Street 1:8811 STATE ROAD 52 STE 11
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-6751
Practice Address - Country:US
Practice Address - Phone:727-233-9908
Practice Address - Fax:727-233-9908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-20
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH289683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy