MEDICARE: RAYMOND L LI 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	RP456129	PA

General Provider Information

NPI Number	:	1619614203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND L LI RPH

Provider Business Mailing Address
First Line	:	4215 CHESTNUT ST STE 204
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-3014
Country	:	US
Telephone Number	:	917-887-9775
Fax Number	:

Provider Business Practice Location Address
First Line	:	4215 CHESTNUT ST STE 204
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-3014
Country	:	US
Telephone Number	:	917-887-9775
Fax Number	:

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

Provider Enumeration Date	:	05/16/2022
Last Update Date	:	05/16/2022

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