Provider Demographics
NPI:1073396180
Name:LY, SANDY FAYE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:FAYE
Last Name:LY
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 1:12674 GATEWAY DR S
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-3307
Mailing Address - Country:US
Mailing Address - Phone:206-639-8237
Mailing Address - Fax:
Practice Address - Street 1:12674 GATEWAY DR S
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-3307
Practice Address - Country:US
Practice Address - Phone:206-639-8237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH0021302183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist