Healthcare Provider Details

I. General information

NPI: 1043975667
Provider Name (Legal Business Name): ANDREW LIU CHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9968 E GRAND RIVER AVE
BRIGHTON MI
48116-1924
US

IV. Provider business mailing address

535 EAGLE WAY
SOUTH LYON MI
48178-2038
US

V. Phone/Fax

Practice location:
  • Phone: 810-225-2275
  • Fax:
Mailing address:
  • Phone: 248-921-0891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302413818
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: