Provider Demographics
NPI:1417578253
Name:LI, CARMEN L (PHARMD, CDCES)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:L
Last Name:LI
Suffix:
Gender:F
Credentials:PHARMD, CDCES
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:
Other - Last Name:LU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:211 QUARRY RD # MC5995
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1416
Mailing Address - Country:US
Mailing Address - Phone:650-785-1559
Mailing Address - Fax:
Practice Address - Street 1:211 QUARRY RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1416
Practice Address - Country:US
Practice Address - Phone:650-736-3641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102221835P0018X
CA733191835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist