Provider Demographics
NPI:1356937304
Name:ANDERSON, LILLIAN KATE (PHARMD)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:KATE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 BARRETT ST APT 6200
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-1700
Mailing Address - Country:US
Mailing Address - Phone:518-669-5168
Mailing Address - Fax:
Practice Address - Street 1:21 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01220-1315
Practice Address - Country:US
Practice Address - Phone:413-743-4659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH239875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist