Healthcare Provider Details

I. General information

NPI: 1417349770
Provider Name (Legal Business Name): ASHLEY LIU PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2015
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 DORSETT VLG
MARYLAND HEIGHTS MO
63043-2208
US

IV. Provider business mailing address

2030 DORSETT VLG
MARYLAND HEIGHTS MO
63043-2208
US

V. Phone/Fax

Practice location:
  • Phone: 314-434-5496
  • Fax:
Mailing address:
  • Phone: 314-434-5496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2012020916
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: