Healthcare Provider Details

I. General information

NPI: 1588380547
Provider Name (Legal Business Name): DAVID LING HUI LIU PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W BASE LINE RD
RIALTO CA
92376-3347
US

IV. Provider business mailing address

300 W BASE LINE RD
RIALTO CA
92376-3347
US

V. Phone/Fax

Practice location:
  • Phone: 909-546-3019
  • Fax:
Mailing address:
  • Phone: 909-546-3019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number86752
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: