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General NPI Number Information
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NPI Number | 1275406209
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Entity Type | Individual
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Provider Name | ANDREW LY
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Gender | Male
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Dates
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Enumeration Date | 09/25/2025
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 751 NE BLAKELY DR
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City | ISSAQUAH
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State | WA
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Zip | 98029-6201
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Country | US
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Telephone | 425-313-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 15300 SE 155TH PL UNIT A307
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City | RENTON
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State | WA
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Zip | 98058-8308
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Country | US
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Telephone | 425-313-5515
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH61364407
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License Number State | WA
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