MEDICARE: KENNY LI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	19870	NV

General Provider Information

NPI Number	:	1174127385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNY LI

Provider Business Mailing Address
First Line	:	6283 JOSHUA PEAK AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-6171
Country	:	US
Telephone Number	:	626-616-3263
Fax Number	:

Provider Business Practice Location Address
First Line	:	1408 W CRAIG RD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0210
Country	:	US
Telephone Number	:	702-642-2680
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2020
Last Update Date	:	11/29/2020

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Directions to “ KENNY LI ” Practice Location

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