Individual
LILY E FORMBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
8924 KANIS RD, LITTLE ROCK, AR 72205-6414
(501) 455-2712
(501) 455-2781
Mailing address
PO BOX 497, AUGUSTA, AR 72006-0497
(870) 347-2534
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2092
AR
Other
Enumeration date
07/20/2021
Last updated
07/26/2021
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