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General NPI Number Information
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NPI Number | 1902251945
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Entity Type | Organization
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Legal Business Name | VINCENT LY PHARMACY INCORPORATION
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Dates
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Enumeration Date | 04/27/2016
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 701 S ATLANTIC BLVD STE 168 SUITE 168
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City | MONTEREY PARK
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State | CA
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Zip | 91754-3866
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Country | US
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Telephone | 626-782-7800
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Fax | 626-782-7755
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Provider Business Mailing Address
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Address Line | 701 S ATLANTIC BLVD SUITE 168
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City | MONTEREY PARK
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State | CA
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Zip | 91754-3844
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Country | US
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Telephone | 626-672-9220
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Fax |
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Authorized Official
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Title or Position | CEO/PHARMACIST IN CHARGE
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Name | VINCENT LY
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Credential |
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Telephone | 626-672-9220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY54380
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License Number State | CA
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