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General NPI Number Information
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NPI Number | 1881297661
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Entity Type | Individual
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Provider Name | KHUONG QUOC LY RPH
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Gender | Male
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Dates
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Enumeration Date | 11/16/2020
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Last Update Date | 11/17/2020
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Provider Practice Location Address
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Address Line | 1496 FM 407
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City | LEWISVILLE
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State | TX
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Zip | 75077-2125
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Country | US
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Telephone | 972-317-2392
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Fax |
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Provider Business Mailing Address
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Address Line | 1128 ANNALEA COVE DR
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City | LEWISVILLE
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State | TX
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Zip | 75056-4176
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Country | US
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Telephone | 214-315-6321
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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 | 61452
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License Number State | TX
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