Provider Demographics
NPI:1588297543
Name:LY, KAREN TRIEU
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:TRIEU
Last Name:LY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 WALNUT GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-3789
Mailing Address - Country:US
Mailing Address - Phone:626-573-5094
Mailing Address - Fax:
Practice Address - Street 1:1827 WALNUT GROVE AVE
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-3789
Practice Address - Country:US
Practice Address - Phone:626-573-5094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81986183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist