Provider Demographics
NPI:1992029094
Name:LI, EUNICE C
Entity Type:Individual
Prefix:
First Name:EUNICE
Middle Name:C
Last Name:LI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 SENATOR ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-5207
Mailing Address - Country:US
Mailing Address - Phone:646-270-6615
Mailing Address - Fax:
Practice Address - Street 1:1235 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-1475
Practice Address - Country:US
Practice Address - Phone:212-570-2710
Practice Address - Fax:212-570-1036
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist