Individual
JACOB ROSS LILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
252 RURAL ACRES DR, BECKLEY, WV 25801-3503
(304) 252-8324
Mailing address
252 RURAL ACRES DR, BECKLEY, WV 25801-3503
(304) 252-8324
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP0007913
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RP0007913
PHARMACIST LICENSE
WV
Enumeration date
09/25/2018
Last updated
09/25/2018
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