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General NPI Number Information
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NPI Number | 1962364976
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Entity Type | Individual
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Provider Name | KEVIN LY RPH
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Gender | Male
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Dates
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Enumeration Date | 11/27/2025
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Last Update Date | 11/27/2025
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Provider Practice Location Address
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Address Line | 2222 N STORY RD
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City | IRVING
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State | TX
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Zip | 75062-7064
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Country | US
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Telephone | 972-255-4155
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Fax |
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Provider Business Mailing Address
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Address Line | 3796 WATERSIDE CT
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City | ADDISON
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State | TX
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Zip | 75001-7948
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Country | US
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Telephone | 469-767-3172
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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 | 38863
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License Number State | TX
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