Healthcare Provider Details

I. General information

NPI: 1891009965
Provider Name (Legal Business Name): SIMON LIEW RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2010
Last Update Date: 08/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 POND ST
ASHLAND MA
01721-2327
US

IV. Provider business mailing address

339 POND ST
ASHLAND MA
01721-2327
US

V. Phone/Fax

Practice location:
  • Phone: 508-881-7311
  • Fax: 508-881-5874
Mailing address:
  • Phone: 508-881-7311
  • Fax: 508-881-5874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21810
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: