MEDICARE: MICHELLE 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	068162	NY

General Provider Information

NPI Number	:	1811667470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE LI

Provider Business Mailing Address
First Line	:	1448 74TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-2208
Country	:	US
Telephone Number	:	646-388-1795
Fax Number	:

Provider Business Practice Location Address
First Line	:	4914 NEW UTRECHT AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-5577
Country	:	US
Telephone Number	:	718-633-4900
Fax Number	:

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

Provider Enumeration Date	:	09/15/2021
Last Update Date	:	09/15/2021

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Directions to “ MICHELLE LI ” Practice Location

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