Individual
DR. KELLY TILLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARM D
Contact information
Practice address
2800 GAUSE BLVD E STE F, SLIDELL, LA 70461-4247
(985) 641-4252
Mailing address
207 BERRYWOOD CT, SLIDELL, LA 70461-4209
(985) 259-9657
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
015932
LA
Other
Enumeration date
09/22/2015
Last updated
09/22/2015
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