Provider Demographics
NPI:1134358583
Name:LY, KHAO YEU (PHARMD,RPH)
Entity type:Individual
Prefix:DR
First Name:KHAO YEU
Middle Name:
Last Name:LY
Suffix:
Gender:F
Credentials:PHARMD,RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 ORANGE AVENUE WEST
Mailing Address - Street 2:
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117
Mailing Address - Country:US
Mailing Address - Phone:651-489-2718
Mailing Address - Fax:651-774-7771
Practice Address - Street 1:1177 CLARENCE STREET
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-2809
Practice Address - Country:US
Practice Address - Phone:651-774-7772
Practice Address - Fax:651-774-7771
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist