Healthcare Provider Details

I. General information

NPI: 1598361958
Provider Name (Legal Business Name): WINSON LI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 9TH ST
BROOKLYN NY
11215-4007
US

IV. Provider business mailing address

341 9TH ST
BROOKLYN NY
11215-4007
US

V. Phone/Fax

Practice location:
  • Phone: 718-499-3414
  • Fax:
Mailing address:
  • Phone: 718-499-3414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number067439
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: