Provider Demographics
NPI:1043346240
Name:LI, IRENE IE-LING (RPH)
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:IE-LING
Last Name:LI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38883 ALTURA ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-4403
Mailing Address - Country:US
Mailing Address - Phone:510-792-1933
Mailing Address - Fax:
Practice Address - Street 1:3744 MOWRY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1428
Practice Address - Country:US
Practice Address - Phone:510-796-2497
Practice Address - Fax:510-796-1322
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist