Individual provider Active NPI

Jeffrey James Lillie, PHARM D

  • Pharmacist
  • Clackamas, OR
National Provider Identifier
1184924532
Registry record updated Jan 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
10833 Issued in OR
Practice address
13130 SE 84TH Ave
Clackamas, OR 97015-9733
Phone
(503) 794-5520
Fax
(503) 794-5528
NPI assigned
Nov 1, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 10833 OR Primary
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X 10833 OR

Addresses

Primary practice location

13130 SE 84TH Ave
Clackamas, OR 97015-9733

Mailing address

13130 SE 84TH Ave
Clackamas, OR 97015-9733
Phone (503) 794-5520

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
10833ORMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1288569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452038400000",
    "number": "1184924532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13130 SE 84TH AVE",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970159733",
            "telephone_number": "503-794-5520",
            "fax_number": "503-794-5528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13130 SE 84TH AVE",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970159733",
            "telephone_number": "503-794-5520",
            "fax_number": "503-794-5528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LILLIE",
        "first_name": "JEFFREY",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "PHARM D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-11-01",
        "last_updated": "2016-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OR",
            "license": "10833",
            "primary": true
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "OR",
            "license": "10833",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clackamas, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.