Individual
LYLY TU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5420 DEWEY DR, FAIR OAKS, CA 95628-3138
(916) 684-4803
Mailing address
5601 WALNUT AVE APT 4, ORANGEVALE, CA 95662-5331
(916) 690-0652
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
TCH89072
CA
Other
Enumeration date
01/08/2021
Last updated
01/08/2021
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