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General NPI Number Information
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NPI Number | 1518218569
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Entity Type | Individual
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Provider Name | MINH TU LY PHARMD
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Gender | Male
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Dates
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Enumeration Date | 09/29/2012
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Last Update Date | 01/17/2014
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Provider Practice Location Address
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Address Line | 2435 E BASELINE RD
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City | PHOENIX
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State | AZ
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Zip | 85042-7004
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Country | US
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Telephone | 602-232-2982
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Fax |
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Provider Business Mailing Address
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Address Line | 2435 E BASELINE RD
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City | PHOENIX
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State | AZ
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Zip | 85042-7004
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Country | US
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Telephone | 602-232-2982
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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 | S019381
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License Number State | AZ
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