Healthcare Provider Details

I. General information

NPI: 1235562257
Provider Name (Legal Business Name): KANGLI CHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 E 22ND ST
TUCSON AZ
85710-5113
US

IV. Provider business mailing address

7050 E 22ND ST
TUCSON AZ
85710-5113
US

V. Phone/Fax

Practice location:
  • Phone: 520-790-9492
  • Fax:
Mailing address:
  • Phone: 520-790-9492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS020028
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: