Healthcare Provider Details

I. General information

NPI: 1083025266
Provider Name (Legal Business Name): JESSICA MONYE FONG LIU PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2014
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4131 GEARY BLVD
SAN FRANCISCO CA
94118-3101
US

IV. Provider business mailing address

111 GALEWOOD CIR
SAN FRANCISCO CA
94131-1131
US

V. Phone/Fax

Practice location:
  • Phone: 877-404-5777
  • Fax:
Mailing address:
  • Phone: 415-203-0289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number69611
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: