Provider Demographics
NPI:1164994893
Name:LI, SUZANNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8723 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4546
Mailing Address - Country:US
Mailing Address - Phone:917-282-4587
Mailing Address - Fax:
Practice Address - Street 1:721 9TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-7256
Practice Address - Country:US
Practice Address - Phone:212-246-0168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064368183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist