Provider Demographics
NPI:1174334197
Name:LY, STEVEN (PHARMACIST)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:LY
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 LONGLEY LN STE 34
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-1817
Mailing Address - Country:US
Mailing Address - Phone:775-721-1395
Mailing Address - Fax:775-470-8478
Practice Address - Street 1:2845 ETHELINDA WAY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-4395
Practice Address - Country:US
Practice Address - Phone:775-721-1395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20148183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist