Provider Demographics
NPI:1326360959
Name:CHEN, LI SHAN
Entity Type:Individual
Prefix:
First Name:LI SHAN
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1813
Mailing Address - Country:US
Mailing Address - Phone:347-351-4636
Mailing Address - Fax:
Practice Address - Street 1:1 PATH PLZ
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2905
Practice Address - Country:US
Practice Address - Phone:201-459-0614
Practice Address - Fax:201-459-0922
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03041600183500000X
NY052471-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist