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General NPI Number Information
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NPI Number | 1770258188
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Entity Type | Individual
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Provider Name | LI TAN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/09/2021
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Last Update Date | 11/20/2022
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Provider Practice Location Address
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Address Line | 415 N LINCOLN BLVD
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City | HODGENVILLE
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State | KY
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Zip | 42748-1610
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Country | US
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Telephone | 270-358-3186
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Fax |
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Provider Business Mailing Address
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Address Line | 110B RALEIGH DR
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-7139
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Country | US
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Telephone | 917-250-0126
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 022157
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License Number State | KY
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