Healthcare Provider Details

I. General information

NPI: 1811593551
Provider Name (Legal Business Name): THIEN LIEU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 KNEELAND ST
BOSTON MA
02111-1523
US

IV. Provider business mailing address

35 KNEELAND ST
BOSTON MA
02111-1523
US

V. Phone/Fax

Practice location:
  • Phone: 617-542-1885
  • Fax:
Mailing address:
  • Phone: 617-542-1885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24249
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: