Healthcare Provider Details

I. General information

NPI: 1720585631
Provider Name (Legal Business Name): LILY LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2018
Last Update Date: 04/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 VALENCIA ST STE 101
SAN FRANCISCO CA
94110-4420
US

IV. Provider business mailing address

1646 45TH AVE
SAN FRANCISCO CA
94122-2939
US

V. Phone/Fax

Practice location:
  • Phone: 415-970-8001
  • Fax:
Mailing address:
  • Phone: 415-828-5698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number77559
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: