Provider Demographics
NPI:1386935898
Name:LI, BENJAMIN (PHARMACIST)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 H ST
Mailing Address - Street 2:500
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-5156
Mailing Address - Country:US
Mailing Address - Phone:360-332-1616
Mailing Address - Fax:360-332-1336
Practice Address - Street 1:1733 H ST
Practice Address - Street 2:500
Practice Address - City:BLAINE
Practice Address - State:WA
Practice Address - Zip Code:98230-5156
Practice Address - Country:US
Practice Address - Phone:360-332-1616
Practice Address - Fax:360-332-1336
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00042643183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist