Provider Demographics
NPI:1023389426
Name:LY, HUONG N (RPH)
Entity type:Individual
Prefix:MISS
First Name:HUONG
Middle Name:N
Last Name:LY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:COURTNEY
Other - Middle Name:N
Other - Last Name:LY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:1810 FREEDOM BLVD.
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076
Mailing Address - Country:US
Mailing Address - Phone:831-768-0183
Mailing Address - Fax:831-768-8749
Practice Address - Street 1:1810 FREEDOM BLVD.
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076
Practice Address - Country:US
Practice Address - Phone:831-768-0183
Practice Address - Fax:831-768-8749
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62932183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist