Provider Demographics
NPI:1346522869
Name:CHONG-LI, VENESSA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:VENESSA
Middle Name:
Last Name:CHONG-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 1:24790 VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2629
Mailing Address - Country:US
Mailing Address - Phone:661-670-2020
Mailing Address - Fax:
Practice Address - Street 1:24790 VALLEY ST
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2629
Practice Address - Country:US
Practice Address - Phone:661-670-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-10
Last Update Date:2014-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48881183500000X
NV13069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA48881OtherSTATE BOARD OF PHARMACY
NV13069OtherSTATE BOARD OF PHARMACY