Healthcare Provider Details

I. General information

NPI: 1538984315
Provider Name (Legal Business Name): AMELIA LY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 E ASHLAN AVE STE 111
FRESNO CA
93726-3021
US

IV. Provider business mailing address

4076 W FIG TREE LN
FRESNO CA
93722-8210
US

V. Phone/Fax

Practice location:
  • Phone: 619-316-7531
  • Fax:
Mailing address:
  • Phone: 619-316-7531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number85739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: