Provider Demographics
NPI:1902183007
Name:LY, TINH NGOC (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TINH
Middle Name:NGOC
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 1:3315 BADGER AVE SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-3052
Mailing Address - Country:US
Mailing Address - Phone:616-232-8929
Mailing Address - Fax:
Practice Address - Street 1:3435 E SAGINAW ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4717
Practice Address - Country:US
Practice Address - Phone:517-351-0249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038053183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist