Healthcare Provider Details

I. General information

NPI: 1457729519
Provider Name (Legal Business Name): DANIEL C LIU PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2015
Last Update Date: 09/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

579 HUNTINGTON DR
SAN MARINO CA
91108-2328
US

IV. Provider business mailing address

579 HUNTINGTON DR
SAN MARINO CA
91108-2328
US

V. Phone/Fax

Practice location:
  • Phone: 626-215-9798
  • Fax:
Mailing address:
  • Phone: 626-215-9798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number73330
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: