Healthcare Provider Details

I. General information

NPI: 1285188318
Provider Name (Legal Business Name): SALLY LIEU PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2016
Last Update Date: 08/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W CAMELBACK RD STE 290
PHOENIX AZ
85015-7403
US

IV. Provider business mailing address

2001 W CAMELBACK RD STE 290
PHOENIX AZ
85015-7403
US

V. Phone/Fax

Practice location:
  • Phone: 602-283-4339
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS022017
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: