Provider Demographics
NPI:1407024318
Name:LI, RAYMOND K (RPH)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:K
Last Name:LI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 TROTTER DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-2507
Mailing Address - Country:US
Mailing Address - Phone:609-953-8228
Mailing Address - Fax:
Practice Address - Street 1:650 W CUTHBERT BLVD
Practice Address - Street 2:
Practice Address - City:HADDON TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08108-3642
Practice Address - Country:US
Practice Address - Phone:856-869-9737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02219100183500000X
PARP-039392-L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP-039392-LOtherSTATE BOARD
NJ28RI02219100OtherSTATE BOARD