Provider Demographics
NPI:1265033054
Name:LI, JENNY SUN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:SUN
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 1:4801 SHEBOYGAN AVE APT 407
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-3015
Mailing Address - Country:US
Mailing Address - Phone:847-875-1160
Mailing Address - Fax:
Practice Address - Street 1:3050 CAHILL MAIN STE 6
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-7137
Practice Address - Country:US
Practice Address - Phone:608-274-3784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20465-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist