Healthcare Provider Details

I. General information

NPI: 1518284561
Provider Name (Legal Business Name): ZIYU LI PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2010
Last Update Date: 04/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 OXFORD AVE
PHILA PA
19111-5400
US

IV. Provider business mailing address

211 KENILWORTH AVE
PHILA PA
19120-1411
US

V. Phone/Fax

Practice location:
  • Phone: 215-745-2557
  • Fax: 215-745-3764
Mailing address:
  • Phone: 215-927-1205
  • Fax: 215-745-3764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP443710
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: