Active NPI
Khao Yeu Ly, PHARM.D.,R.PH.
- Pharmacist
- Saint Paul, MN
National Provider Identifier
1134358583
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 117872
- Practice address
- 1177 Clarence Street
Saint Paul, MN 55106-2809 - Phone
- (651) 774-7772
- Fax
- (651) 774-7771
- NPI assigned
- Jul 7, 2009
- Last updated
- Jul 7, 2009
- Sex
- Female
- 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 | 117872 | MN | Primary |
Addresses
Primary practice location
1177 Clarence Street
Saint Paul, MN 55106-2809
Mailing address
85 Orange Avenue West
St Paul, MN 55117
Phone (651) 489-2718
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
- Credentials
- Doctor of Pharmacy, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 117872 | MN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Supervalu Pharmacies Inc. | Past | Accepting new patients | |
| Supervalu Pharmacies Inc | Past | Accepting new patients |
Organizations & group practices 2
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": "1246924800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1246924800000",
"number": "1134358583",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "85 ORANGE AVENUE WEST",
"city": "ST PAUL",
"state": "MN",
"postal_code": "55117",
"telephone_number": "651-489-2718",
"fax_number": "651-774-7771"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1177 CLARENCE STREET",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551062809",
"telephone_number": "651-774-7772",
"fax_number": "651-774-7771"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LY",
"first_name": "KHAO YEU",
"name_prefix": "Dr.",
"credential": "PHARM.D.,R.PH.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-07-07",
"last_updated": "2009-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "117872",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.