Provider Demographics
NPI:1720238728
Name:GOLSON, LILLIE D (RPH)
Entity Type:Individual
Prefix:MS
First Name:LILLIE
Middle Name:D
Last Name:GOLSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7520 STANDISH PL
Mailing Address - Street 2:ROOM 2332
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20855-7706
Mailing Address - Country:US
Mailing Address - Phone:240-276-8994
Mailing Address - Fax:240-276-8999
Practice Address - Street 1:VETERANS AFFAIRS MEDICAL CTR
Practice Address - Street 2:50 IRVING STREET, NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20422-0001
Practice Address - Country:US
Practice Address - Phone:202-745-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10997183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD183500000XMedicaid