Active NPI
Thanh Ly
- Pharmacist
- Vancouver, WA
National Provider Identifier
1376044222
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 61319269
- Practice address
- 12607 SE Mill Plain BLCD
Vancouver, WA 98684 - Phone
- (866) 279-1758
- NPI assigned
- Feb 26, 2018
- Last updated
- Nov 13, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0016478 | OR | |
| Pharmacist | 183500000X | 61319269 | WA | Primary |
Addresses
Primary practice location
12607 SE Mill Plain BLCD
Vancouver, WA 98684
Mailing address
10500 SW 130TH Ave
Beaverton, OR 97008-8162
Phone (503) 780-8201
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 |
|---|---|---|---|
| 0016478 | OR | MD | Pharmacist |
| 61319269 | WA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | 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": "1519603200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731456000000",
"number": "1376044222",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10500 SW 130TH AVE",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970088162",
"telephone_number": "503-780-8201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12607 SE MILL PLAIN BLCD",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "98684",
"telephone_number": "866-279-1758"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LY",
"first_name": "THANH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-02-26",
"last_updated": "2024-11-13",
"certification_date": "2024-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "0016478",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "61319269",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.