Individual
HENAN LI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4240 YELLOWSTONE AVE, POCATELLO, ID 83202-2420
(208) 237-5091
Mailing address
4240 YELLOWSTONE AVE, POCATELLO, ID 83202-2420
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
CS15129
ID
183500000X
Pharmacist
P6474
ID
Other
Enumeration date
08/14/2014
Last updated
08/14/2014
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