Provider Demographics
NPI:1649679226
Name:ELAD, LILIAN TIAYO
Entity type:Individual
Prefix:DR
First Name:LILIAN
Middle Name:TIAYO
Last Name:ELAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LILIAN
Other - Middle Name:TIAYO
Other - Last Name:ELAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1901 MORAN DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-6444
Mailing Address - Country:US
Mailing Address - Phone:240-350-4739
Mailing Address - Fax:
Practice Address - Street 1:8032C LIBERTY RD
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-3239
Practice Address - Country:US
Practice Address - Phone:301-846-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19479183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist