Healthcare Provider Details

I. General information

NPI: 1790522274
Provider Name (Legal Business Name): ZHIXI LIU PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11109 PARKVIEW PLAZA DR
FORT WAYNE IN
46845-1701
US

IV. Provider business mailing address

13166 UNION CLUB BLVD APT 806
FORT WAYNE IN
46845-1395
US

V. Phone/Fax

Practice location:
  • Phone: 260-266-1000
  • Fax:
Mailing address:
  • Phone: 419-908-9748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26030797A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: