Active NPI
Brian Ly
- Pharmacist
- Venice, CA
National Provider Identifier
1053823351
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 76270
- Practice address
- 255 Main St
Venice, CA 90291-5217 - Phone
- (310) 399-2436
- Fax
- (310) 399-2804
- NPI assigned
- Oct 27, 2017
- Last updated
- Oct 27, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 76270 | CA | Primary |
Addresses
Primary practice location
255 Main St
Venice, CA 90291-5217
Mailing address
1715 259TH St Unit 17
Lomita, CA 90717-3357
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 76270 | CA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Longs Drug Store California LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1509062400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1509062400000",
"number": "1053823351",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1715 259TH ST UNIT 17",
"city": "LOMITA",
"state": "CA",
"postal_code": "907173357"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "255 MAIN ST",
"city": "VENICE",
"state": "CA",
"postal_code": "902915217",
"telephone_number": "310-399-2436",
"fax_number": "310-399-2804"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LY",
"first_name": "BRIAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-10-27",
"last_updated": "2017-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "76270",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Venice, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.