MEDICARE: SUMIN LI PH.D., B.PHARM

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	PH60092404	WA

General Provider Information

NPI Number	:	1407174352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUMIN LI PH.D., B.PHARM

Provider Business Mailing Address
First Line	:	9062 E SHOREWOOD DR APT 159
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-3294
Country	:	US
Telephone Number	:	201-887-5002
Fax Number	:

Provider Business Practice Location Address
First Line	:	3023 78TH AVE SE
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-2822
Country	:	US
Telephone Number	:	206-236-0776
Fax Number	:

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

Provider Enumeration Date	:	05/16/2010
Last Update Date	:	05/16/2010

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