Healthcare Provider Details

I. General information

NPI: 1386980886
Provider Name (Legal Business Name): MICHAEL JEREMY LIEVERS PHARMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2013
Last Update Date: 01/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4751 BEST RD
COLLEGE PARK GA
30337-5615
US

IV. Provider business mailing address

4751 BEST RD
COLLEGE PARK GA
30337-5615
US

V. Phone/Fax

Practice location:
  • Phone: 404-766-2012
  • Fax:
Mailing address:
  • Phone: 404-766-2012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number019309
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number019309
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number019309
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: