Healthcare Provider Details

I. General information

NPI: 1295644003
Provider Name (Legal Business Name): CHI JUNG LIAO RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JUNG CHI LIAO RPH

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 W ALLUVIAL AVE STE 101
FRESNO CA
93711-5509
US

IV. Provider business mailing address

11151 SANTA ROSALIA ST
STANTON CA
90680-3134
US

V. Phone/Fax

Practice location:
  • Phone: 800-797-3543
  • Fax:
Mailing address:
  • Phone: 714-759-0027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number92827
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: