Active NPI
Andy Ly
- Pharmacist
- Philadelphia, PA
National Provider Identifier
1871163493
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RP45701
- Practice address
- 8200 Roosevelt Blvd
Philadelphia, PA 19152-2519 - Phone
- (215) 338-4967
- Fax
- (215) 338-2437
- NPI assigned
- Jun 27, 2021
- Last updated
- Aug 16, 2022
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RP45701 | PA | Primary |
Addresses
Primary practice location
8200 Roosevelt Blvd
Philadelphia, PA 19152-2519
Mailing address
4010 K St
Philadelphia, PA 19124-5219
Phone (267) 250-1086
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 |
|---|---|---|---|
| RP45701 | PA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Acme Markets Inc | Past | Accepting new patients | |
| Acme Markets 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": "1624752000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660608000000",
"number": "1871163493",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4010 K ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191245219",
"telephone_number": "267-250-1086"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8200 ROOSEVELT BLVD",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191522519",
"telephone_number": "215-338-4967",
"fax_number": "215-338-2437"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LY",
"first_name": "ANDY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-06-27",
"last_updated": "2022-08-16",
"certification_date": "2022-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "PA",
"license": "RP45701",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.