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NPI Code Detail

MEDICARE: KELLY LI

MEDICARE: KELLY LI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist77368CA

General Provider Information

NPI Number : 1053046458
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY LI
Provider Business Mailing Address
First Line : 1500 DUARTE RD
Second Line :
City : DUARTE
State : CA
Zip : 91010-3012
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1500 DUARTE RD
Second Line :
City : DUARTE
State : CA
Zip : 91010-3012
Country : US
Telephone Number : 626-256-4673
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2022
Last Update Date : 03/18/2026

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Directions to “ KELLY LI ” Practice Location

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