Provider Demographics
NPI:1811455587
Name:LY, BINH
Entity type:Individual
Prefix:
First Name:BINH
Middle Name:
Last Name:LY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14656 AMBAUM BLVD SW
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1810
Mailing Address - Country:US
Mailing Address - Phone:206-901-1816
Mailing Address - Fax:206-901-1894
Practice Address - Street 1:14656 AMBAUM BLVD SW
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1810
Practice Address - Country:US
Practice Address - Phone:206-901-1816
Practice Address - Fax:206-901-1894
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-12
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-14472183500000X
ORRPH-0016138183500000X
WAPH60700503183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist