Provider Demographics
NPI:1295015857
Name:LI, CHUNG-LI JASON (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHUNG-LI
Middle Name:JASON
Last Name:LI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 BLACKFORD WAY
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-1876
Mailing Address - Country:US
Mailing Address - Phone:904-436-0006
Mailing Address - Fax:904-797-6569
Practice Address - Street 1:116 BLACKFORD WAY
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-1876
Practice Address - Country:US
Practice Address - Phone:904-436-0006
Practice Address - Fax:904-797-6569
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34480183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist