Provider Demographics
NPI:1770933327
Name:LI, RICKY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RICKY
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E RANDOLPH ST
Mailing Address - Street 2:#3721
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7329
Mailing Address - Country:US
Mailing Address - Phone:630-930-9241
Mailing Address - Fax:
Practice Address - Street 1:400 E RANDOLPH ST
Practice Address - Street 2:#3721
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7329
Practice Address - Country:US
Practice Address - Phone:630-930-9241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.298502183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist