Provider Demographics
NPI:1477853745
Name:LY, LINDA (PHARM D)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:LY
Suffix:
Gender:F
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 1:215 DEININGER CIR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92878-3207
Mailing Address - Country:US
Mailing Address - Phone:866-443-0060
Mailing Address - Fax:866-443-0066
Practice Address - Street 1:215 DEININGER CIR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92878-3207
Practice Address - Country:US
Practice Address - Phone:866-443-0060
Practice Address - Fax:866-443-0066
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52047183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist