Provider Demographics
NPI:1285912709
Name:DANG, LY PHAM (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LY
Middle Name:PHAM
Last Name:DANG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-7004
Mailing Address - Country:US
Mailing Address - Phone:909-793-2619
Mailing Address - Fax:
Practice Address - Street 1:1271 N STATE ST
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-6315
Practice Address - Country:US
Practice Address - Phone:951-654-4221
Practice Address - Fax:951-654-4466
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51765183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist