Individual
BAO VY THI LY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2233 W US HIGHWAY 90, LAKE CITY, FL 32055-4761
(386) 752-8090
Mailing address
174 RICHMOND DR, SAINT JOHNS, FL 32259-8028
(571) 545-1581
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
0202222077
VA
183500000X
Pharmacist
Primary
PS67516
FL
Other
Enumeration date
06/27/2024
Last updated
08/27/2024
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