Dylan Vuduy Ly, PHARMD

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

S019451 Issued in AZ

Practice address

650 Elm St
Page, AZ 86040

Phone

(928) 645-5714

NPI assigned

Sep 19, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

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.

• Safeway Inc

  • Community/Retail Pharmacy
  • Page, AZ
  • NPI 1447289491
  NPD (past)
• Safeway Inc

  • Community/Retail Pharmacy
  • Queen Creek, AZ
  • NPI 1730040973
  NPD (past)

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

{
    "created_epoch": "1348012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348617600000",
    "number": "1134479918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 ELM ST",
            "city": "PAGE",
            "state": "AZ",
            "postal_code": "86040",
            "telephone_number": "928-645-5714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 ELM ST",
            "city": "PAGE",
            "state": "AZ",
            "postal_code": "86040",
            "telephone_number": "928-645-5714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LY",
        "first_name": "DYLAN",
        "middle_name": "VUDUY",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-09-19",
        "last_updated": "2012-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "AZ",
            "license": "S019451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie A Lindholm, MD
• Christopher Linskey, M.D.
• Mark Longo, RPH
• John W. Loosle, MSW
• Damian Loucks
• Ronald Grant Macdonald Jr., LPC, LISAC
• Mallavia OD PC
• David F Mallavia, OD
• Jeanie Manson, LISAC
• Theodore Martin

• All providers in Page, AZ
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2012; 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.