Healthcare Provider Details

I. General information

NPI: 1720552698
Provider Name (Legal Business Name): LIANA CHOWDHURY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 W SHAW AVE
FRESNO CA
93704-2301
US

IV. Provider business mailing address

5171 VENICE BLVD
LOS ANGELES CA
90019-5201
US

V. Phone/Fax

Practice location:
  • Phone: 559-226-1485
  • Fax:
Mailing address:
  • Phone: 323-646-2330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number78488
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0519047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: