Healthcare Provider Details

I. General information

NPI: 1619216652
Provider Name (Legal Business Name): TINA CAMANH LI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAM ANH THI LAM PHARMD

II. Dates (important events)

Enumeration Date: 02/12/2013
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 HOLMES ST
LIVERMORE CA
94550-6015
US

IV. Provider business mailing address

108 BOXFORD PL
SAN RAMON CA
94583-3314
US

V. Phone/Fax

Practice location:
  • Phone: 925-447-7762
  • Fax:
Mailing address:
  • Phone: 916-216-4122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number65635
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: