Healthcare Provider Details

I. General information

NPI: 1609009430
Provider Name (Legal Business Name): VINCENT LI PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 LENNON LN
WALNUT CREEK CA
94598-2419
US

IV. Provider business mailing address

320 LENNON LN
WALNUT CREEK CA
94598-2419
US

V. Phone/Fax

Practice location:
  • Phone: 925-906-2371
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number62647
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number62647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: