Healthcare Provider Details

I. General information

NPI: 1194497008
Provider Name (Legal Business Name): JIAYING LI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MCCLENNAN BANKS DR
CHARLESTON SC
29401-1164
US

IV. Provider business mailing address

7672 EAGLE LAKE RD
NORTH CHARLESTON SC
29418-2166
US

V. Phone/Fax

Practice location:
  • Phone: 843-876-0199
  • Fax:
Mailing address:
  • Phone: 843-302-6570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43081
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: