Healthcare Provider Details

I. General information

NPI: 1114370673
Provider Name (Legal Business Name): MARY LIEN PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 W 84TH AVE
DENVER CO
80260-4786
US

IV. Provider business mailing address

78 N MCCULLOCH BLVD
PUEBLO WEST CO
81007-4444
US

V. Phone/Fax

Practice location:
  • Phone: 303-427-9176
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number19982
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: