Healthcare Provider Details

I. General information

NPI: 1265012413
Provider Name (Legal Business Name): YI-RUI LYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5256 BURNET RD STE B
AUSTIN TX
78756-2403
US

IV. Provider business mailing address

5256 BURNET RD STE B
AUSTIN TX
78756-2403
US

V. Phone/Fax

Practice location:
  • Phone: 512-452-9471
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number65712
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: