Provider Demographics
NPI:1467797928
Name:LI, MICHAEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 LIND AVE SW
Mailing Address - Street 2:SUITE 130
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-3323
Mailing Address - Country:US
Mailing Address - Phone:425-687-4400
Mailing Address - Fax:425-687-4401
Practice Address - Street 1:2201 LIND AVE SW
Practice Address - Street 2:SUITE 130
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-3323
Practice Address - Country:US
Practice Address - Phone:425-687-4400
Practice Address - Fax:425-687-4401
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH601590391835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist