Healthcare Provider Details

I. General information

NPI: 1245762467
Provider Name (Legal Business Name): ALINE LIEU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4648 KINGSPARK DR
SAN JOSE CA
95136-2324
US

IV. Provider business mailing address

4648 KINGSPARK DR.
SAN JOSE CA
95136-2325
US

V. Phone/Fax

Practice location:
  • Phone: 408-313-5364
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number72935
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: