Provider Demographics
NPI:1700173531
Name:KHA, LY P (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LY
Middle Name:P
Last Name:KHA
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 1:1401 W GLADE RD
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-5417
Mailing Address - Country:US
Mailing Address - Phone:817-399-8486
Mailing Address - Fax:
Practice Address - Street 1:1401 W GLADE RD
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-5417
Practice Address - Country:US
Practice Address - Phone:817-399-8486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44230183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist