MEDICARE: THOA LY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	21775	NC

General Provider Information

NPI Number	:	1033501226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOA LY

Provider Business Mailing Address
First Line	:	9002 SEAMILL RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28278-8007
Country	:	US
Telephone Number	:	857-891-9032
Fax Number	:

Provider Business Practice Location Address
First Line	:	9002 SEAMILL RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28278-8007
Country	:	US
Telephone Number	:	857-891-9032
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2015
Last Update Date	:	02/24/2015

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Directions to “ THOA LY ” Practice Location

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