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General NPI Number Information
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NPI Number | 1598365835
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Entity Type | Individual
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Provider Name | THIEN BAO LY PHARM.D
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Gender | Male
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Dates
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Enumeration Date | 10/27/2020
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 717 W BERRY ST
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City | FORT WORTH
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State | TX
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Zip | 76110-3530
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Country | US
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Telephone | 817-840-0262
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Fax |
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Provider Business Mailing Address
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Address Line | 5519 GREENWICH DR
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City | ARLINGTON
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State | TX
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Zip | 76018-2333
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Country | US
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Telephone | 817-703-7691
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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 | 59348
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License Number State | TX
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