Provider Demographics
NPI:1336487172
Name:LY, THOMAS THANG DAI (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:THANG DAI
Last Name:LY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 E LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76103-3223
Mailing Address - Country:US
Mailing Address - Phone:817-413-7222
Mailing Address - Fax:817-413-7495
Practice Address - Street 1:4200 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103-3223
Practice Address - Country:US
Practice Address - Phone:817-413-7222
Practice Address - Fax:817-413-7495
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52513183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist