Provider Demographics
NPI:1154653756
Name:LI, SIU FUNG (RPH)
Entity Type:Individual
Prefix:MR
First Name:SIU FUNG
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:SIU FUNG
Other - Last Name:LI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8114 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-2450
Mailing Address - Country:US
Mailing Address - Phone:718-803-1188
Mailing Address - Fax:
Practice Address - Street 1:8114 BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-2450
Practice Address - Country:US
Practice Address - Phone:718-803-1188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-06
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI051006-1183500000X
CTPCT0009336183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist