Lan Ly

Primary specialty

PharmacistTaxonomy code 183500000X

License

PH61024074 Issued in WA

Practice address

1800 Cooks Hill Rd Ste B
Centralia, WA 98531-9162

Phone

(360) 827-6616

Fax

(360) 827-6657

NPI assigned

Oct 12, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Providence Health & Services Washington

  • Radiation Oncology Clinic/Center
  • Aberdeen, WA
  • NPI 1457721250
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1507766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595462400000",
    "number": "1073024402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 COOKS HILL RD STE B",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985319162",
            "telephone_number": "360-827-6616",
            "fax_number": "360-827-6657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 COOKS HILL RD STE B",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985319162",
            "telephone_number": "360-827-6616",
            "fax_number": "360-827-6657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LY",
        "first_name": "LAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-12",
        "last_updated": "2020-07-23",
        "certification_date": "2020-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "62504",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WA",
            "license": "PH61024074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vicki Lee Lucht, LPN
• Emily Lund, LMP
• Adam Lutz
• Emily Lutz, LMHCA
• Duong Dai Ly, DDS
• Ryan Caleb Maas
• Andrew J Maasdam, CRNA
• Christopher Maccausland, D.O.
• Darlenny Macedo-Villanueva
• Tonya Arlene Mackey, MSW

• Pharmacist in Centralia, WA
• Providers in Centralia, WA by specialty
• Pharmacist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.