Provider Demographics
NPI:1760884639
Name:LY, DAVIN LUU (PHARMD)
Entity Type:Individual
Prefix:
First Name:DAVIN
Middle Name:LUU
Last Name:LY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 TOWN CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-7131
Mailing Address - Country:US
Mailing Address - Phone:916-605-0185
Mailing Address - Fax:
Practice Address - Street 1:4400 TOWN CENTER BLVD
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-7131
Practice Address - Country:US
Practice Address - Phone:916-605-0185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71543183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist