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General NPI Number Information
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NPI Number | 1780101469
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Entity Type | Individual
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Provider Name | PHUNG KIM LY
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Gender | Female
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Dates
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Enumeration Date | 08/24/2017
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Last Update Date | 03/14/2022
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Provider Practice Location Address
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Address Line | 703 W VALLEY BLVD
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City | ALHAMBRA
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State | CA
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Zip | 91803-3232
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Country | US
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Telephone | 626-289-1990
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Fax |
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Provider Business Mailing Address
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Address Line | 88 S MARENGO AVE UNIT C
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City | ALHAMBRA
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State | CA
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Zip | 91801-1950
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Country | US
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Telephone | 571-232-9363
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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 | 74397
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License Number State | CA
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