MEDICARE: DINGYU LI PHARMACIST

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
1	183500000X	Pharmacist	051291045	IL

General Provider Information

NPI Number	:	1073893715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DINGYU LI PHARMACIST

Provider Business Mailing Address
First Line	:	3304 S OAKLEY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-6025
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3304 S OAKLEY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-6025
Country	:	US
Telephone Number	:	312-504-6179
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2011
Last Update Date	:	08/25/2011

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