MEDICARE: LI H HOM RPH

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	046766	NY

General Provider Information

NPI Number	:	1356600621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LI H HOM RPH

Provider Business Mailing Address
First Line	:	301 E KINGSBRIDGE RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-4443
Country	:	US
Telephone Number	:	929-329-0421
Fax Number	:	347-542-3034

Provider Business Practice Location Address
First Line	:	301 E KINGSBRIDGE RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-4443
Country	:	US
Telephone Number	:	929-329-0421
Fax Number	:	347-542-3034

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

Provider Enumeration Date	:	05/08/2012
Last Update Date	:	11/24/2017

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Directions to “ LI H HOM RPH” Practice Location

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