Provider Demographics
NPI:1558620468
Name:LY, SON (PHARM D)
Entity Type:Individual
Prefix:
First Name:SON
Middle Name:
Last Name:LY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:SHAWN
Other - Middle Name:
Other - Last Name:LY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:8530 EVERGREEN WAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-2614
Mailing Address - Country:US
Mailing Address - Phone:425-348-8433
Mailing Address - Fax:425-348-8422
Practice Address - Street 1:8530 EVERGREEN WAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-2614
Practice Address - Country:US
Practice Address - Phone:425-348-8433
Practice Address - Fax:425-348-8422
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60091713183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist