MEDICARE: ALINE LIEU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	72935	CA

General Provider Information

NPI Number	:	1245762467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALINE LIEU

Provider Business Mailing Address
First Line	:	4648 KINGSPARK DR.
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95136-2325
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4648 KINGSPARK DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95136-2324
Country	:	US
Telephone Number	:	408-313-5364
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2017
Last Update Date	:	03/28/2017

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Directions to “ ALINE LIEU ” Practice Location

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