Provider Demographics
NPI:1659865673
Name:LI, EDWARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
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 1:11307 POTOMAC OAKS DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3521
Mailing Address - Country:US
Mailing Address - Phone:301-315-2699
Mailing Address - Fax:
Practice Address - Street 1:5110 NICHOLSON LANE
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895
Practice Address - Country:US
Practice Address - Phone:301-881-0646
Practice Address - Fax:301-881-2198
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12235183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist