Provider Demographics
NPI:1225596109
Name:NY, SOVANNDARA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SOVANNDARA
Middle Name:
Last Name:NY
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 1:17731 ALEXANDER PL
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-8805
Mailing Address - Country:US
Mailing Address - Phone:562-526-2341
Mailing Address - Fax:
Practice Address - Street 1:9521 DALEN ST
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-4847
Practice Address - Country:US
Practice Address - Phone:562-401-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50570183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist