Healthcare Provider Details

I. General information

NPI: 1932658515
Provider Name (Legal Business Name): ERIC LIU PHARM.D., M.B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2016
Last Update Date: 09/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 28TH ST SE
GRAND RAPIDS MI
49512-2049
US

IV. Provider business mailing address

5100 28TH ST SE
GRAND RAPIDS MI
49512-2049
US

V. Phone/Fax

Practice location:
  • Phone: 616-233-4428
  • Fax:
Mailing address:
  • Phone: 616-233-4428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302044857
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: