Provider Demographics
NPI:1619216652
Name:LI, TINA CAMANH (PHARMD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:CAMANH
Last Name:LI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CAM ANH
Other - Middle Name:THI
Other - Last Name:LAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:108 BOXFORD PL
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-3314
Mailing Address - Country:US
Mailing Address - Phone:916-216-4122
Mailing Address - Fax:
Practice Address - Street 1:1951 HOLMES ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-6015
Practice Address - Country:US
Practice Address - Phone:925-447-7762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65635183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist