Provider Demographics
NPI:1871175125
Name:REMBERT, LILLIAN SHYLISA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:SHYLISA
Last Name:REMBERT
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 1:9969 BOXELDER BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526-4543
Mailing Address - Country:US
Mailing Address - Phone:847-702-6720
Mailing Address - Fax:
Practice Address - Street 1:3880 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2802
Practice Address - Country:US
Practice Address - Phone:850-433-6473
Practice Address - Fax:850-436-4915
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS53417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1649374513Medicaid