Provider Demographics
NPI:1679145098
Name:LY, JILL (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:LY
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 E CAPITOL EXPY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-2415
Mailing Address - Country:US
Mailing Address - Phone:408-626-6060
Mailing Address - Fax:408-629-2544
Practice Address - Street 1:3694 CADWALLADER AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1103
Practice Address - Country:US
Practice Address - Phone:408-646-2462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA161512183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician