Provider Demographics
NPI:1063745750
Name:LI, DORIS (PHARM D)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SPRING ST APT 2T
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-4137
Mailing Address - Country:US
Mailing Address - Phone:646-251-3035
Mailing Address - Fax:
Practice Address - Street 1:196 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4562
Practice Address - Country:US
Practice Address - Phone:212-608-1668
Practice Address - Fax:212-608-1008
Is Sole Proprietor?:No
Enumeration Date:2009-09-12
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053848183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist