Provider Demographics
NPI:1184924532
Name:LILLIE, JEFFREY JAMES (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JAMES
Last Name:LILLIE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13130 SE 84TH AVE
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-9733
Mailing Address - Country:US
Mailing Address - Phone:503-794-5520
Mailing Address - Fax:503-794-5528
Practice Address - Street 1:13130 SE 84TH AVE
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9733
Practice Address - Country:US
Practice Address - Phone:503-794-5520
Practice Address - Fax:503-794-5528
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10833183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist