Healthcare Provider Details

I. General information

NPI: 1245677285
Provider Name (Legal Business Name): NICOLE ANECIA LIU PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2013
Last Update Date: 05/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 ORLEANS ST
BALTIMORE MD
21224-1020
US

IV. Provider business mailing address

2323 ORLEANS ST
BALTIMORE MD
21224-1020
US

V. Phone/Fax

Practice location:
  • Phone: 410-558-4775
  • Fax: 410-732-0162
Mailing address:
  • Phone: 410-558-4775
  • Fax: 410-732-0162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18063
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: