Individual
BAO G LY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
2336 MIRAGE CT, SANTA ROSA, CA 95403-7611
(707) 934-5378
Mailing address
2336 MIRAGE CT, SANTA ROSA, CA 95403-7611
(707) 934-5378
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
RP455496
PA
183500000X
Pharmacist
Primary
RPH84130
CA
Other
Enumeration date
03/16/2021
Last updated
03/17/2021
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