Individual
MR. ETHAN LY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12830 WALKER BRANCH RD, CHARLOTTE, NC 28273-8850
(704) 583-2602
Mailing address
12830 WALKER BRANCH RD, CHARLOTTE, NC 28273-8850
(704) 583-2602
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
28500
NC
Other
Enumeration date
12/26/2020
Last updated
02/12/2021
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