Provider Demographics
NPI:1376059535
Name:MA, LI
Entity Type:Individual
Prefix:DR
First Name:LI
Middle Name:
Last Name:MA
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 1:2040 MONROE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2031
Mailing Address - Country:US
Mailing Address - Phone:585-766-3959
Mailing Address - Fax:
Practice Address - Street 1:18 E 183RD ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-1241
Practice Address - Country:US
Practice Address - Phone:718-841-9969
Practice Address - Fax:718-450-8457
Is Sole Proprietor?:No
Enumeration Date:2017-12-22
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63635183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist