Provider Demographics
NPI:1982955084
Name:LILLYBLAD, MATTHEW PAUL (PHARMD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PAUL
Last Name:LILLYBLAD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 PARK AVE
Mailing Address - Street 2:HCMC INPATIENT PHARMACY- RED LOWER LEVEL
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:612-873-4523
Mailing Address - Fax:612-904-4286
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:HCMC INPATIENT PHARMACY- RED LOWER LEVEL
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-4523
Practice Address - Fax:612-904-4286
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120017183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist