Active NPI
Khuong Quoc Ly, RPH
- Pharmacist
- Lewisville, TX
National Provider Identifier
1881297661
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 61452
- Practice address
- 1496 FM 407
Lewisville, TX 75077-2125 - Phone
- (972) 317-2392
- NPI assigned
- Nov 16, 2020
- Last updated
- Nov 17, 2020
- Sex
- Male
- 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 | 61452 | TX | Primary |
Addresses
Primary practice location
1496 FM 407
Lewisville, TX 75077-2125
Mailing address
1128 Annalea Cove Dr
Lewisville, TX 75056-4176
Phone (214) 315-6321
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61452 | TX | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CVS Pharmacy Inc | Past | Accepting new patients | |
| CVS Pharmacy, 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": "1605484800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605571200000",
"number": "1881297661",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1128 ANNALEA COVE DR",
"city": "LEWISVILLE",
"state": "TX",
"postal_code": "750564176",
"telephone_number": "214-315-6321"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1496 FM 407",
"city": "LEWISVILLE",
"state": "TX",
"postal_code": "750772125",
"telephone_number": "972-317-2392"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LY",
"first_name": "KHUONG",
"middle_name": "QUOC",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-11-16",
"last_updated": "2020-11-17",
"certification_date": "2020-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "61452",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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- Mabel's Place
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 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.