Provider Demographics
NPI:1811599921
Name:LY, ANDREA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
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 1:831 STERLING PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-7323
Mailing Address - Country:US
Mailing Address - Phone:858-201-8832
Mailing Address - Fax:
Practice Address - Street 1:831 STERLING PKWY STE 120
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-7323
Practice Address - Country:US
Practice Address - Phone:916-209-3618
Practice Address - Fax:916-209-3634
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist