Provider Demographics
NPI:1043505902
Name:LI, WU CHENG
Entity Type:Individual
Prefix:
First Name:WU
Middle Name:CHENG
Last Name:LI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18101 NW EVERGREEN PKWY
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-7439
Mailing Address - Country:US
Mailing Address - Phone:503-207-0041
Mailing Address - Fax:
Practice Address - Street 1:18101 NW EVERGREEN PKWY
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7439
Practice Address - Country:US
Practice Address - Phone:503-207-0041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0011219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist