Provider Demographics
NPI:1487185062
Name:LI, JANICE WENJUAN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:WENJUAN
Last Name:LI
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91755-6717
Mailing Address - Country:US
Mailing Address - Phone:626-466-8504
Mailing Address - Fax:
Practice Address - Street 1:3746 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-1704
Practice Address - Country:US
Practice Address - Phone:323-261-3504
Practice Address - Fax:323-261-1266
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist