Healthcare Provider Details

I. General information

NPI: 1548045750
Provider Name (Legal Business Name): BRYANT LI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date: 09/22/2024
Reactivation Date: 10/11/2024

III. Provider practice location address

3240 ARDEN WAY
SACRAMENTO CA
95825-2015
US

IV. Provider business mailing address

2305 JEFFERSON BLVD UNIT 2208
WEST SACRAMENTO CA
95691-5773
US

V. Phone/Fax

Practice location:
  • Phone: 916-614-4060
  • Fax:
Mailing address:
  • Phone: 925-895-1512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberINT49182
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH-0020239
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH90784
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH61567519
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: