Healthcare Provider Details

I. General information

NPI: 1033636303
Provider Name (Legal Business Name): MARY LIU PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2017
Last Update Date: 08/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11080 GREENWELL SPRINGS RD
BATON ROUGE LA
70814-7001
US

IV. Provider business mailing address

11080 GREENWELL SPRINGS RD
BATON ROUGE LA
70814-7001
US

V. Phone/Fax

Practice location:
  • Phone: 225-273-9397
  • 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 NumberPST.022136
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: