Provider Demographics
NPI:1437427275
Name:LY, LIEN T (PHARMD)
Entity Type:Individual
Prefix:
First Name:LIEN
Middle Name:T
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 1:3447 IVAR AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-2837
Mailing Address - Country:US
Mailing Address - Phone:626-382-8852
Mailing Address - Fax:
Practice Address - Street 1:495 E HOLT AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-5539
Practice Address - Country:US
Practice Address - Phone:909-469-9534
Practice Address - Fax:909-469-9577
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56594183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist