Provider Demographics
NPI:1942718259
Name:QI, ELIZABETH REN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:REN
Last Name:QI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9670 LAS TUNAS DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-2139
Mailing Address - Country:US
Mailing Address - Phone:626-872-6406
Mailing Address - Fax:
Practice Address - Street 1:9670 LAS TUNAS DR
Practice Address - Street 2:
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-2139
Practice Address - Country:US
Practice Address - Phone:626-872-6406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-21
Last Update Date:2018-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77224183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist