Healthcare Provider Details

I. General information

NPI: 1700239274
Provider Name (Legal Business Name): BOWEN LIU PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHIEF EDDIE HOFFMAN HWY
BETHEL AK
99559
US

IV. Provider business mailing address

6574 SAUNDERS ST 3J
REGO PARK NY
11374-4254
US

V. Phone/Fax

Practice location:
  • Phone: 907-543-6000
  • Fax:
Mailing address:
  • Phone: 646-204-8199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number107556
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: