Individual
JASON LI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1201 S STATE ST, BIG RAPIDS, MI 49307-2747
(231) 591-2000
Mailing address
1810 MACKWOOD RD, ROCHESTER HILLS, MI 48307-4317
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PS64013
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PS64013
PHARMACIST LICENSE
FL
Enumeration date
08/04/2021
Last updated
06/07/2022
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