Provider Demographics
NPI:1417545468
Name:LY, CARRIE LYNN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:LYNN
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 1:1231 BENEVA RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-3152
Mailing Address - Country:US
Mailing Address - Phone:941-365-4353
Mailing Address - Fax:941-316-0846
Practice Address - Street 1:1231 BENEVA RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-3152
Practice Address - Country:US
Practice Address - Phone:941-365-4353
Practice Address - Fax:941-316-0846
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43287183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist