Healthcare Provider Details

I. General information

NPI: 1518769801
Provider Name (Legal Business Name): JENNY LIU
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 RUNYON ST
HILLSBOROUGH NJ
08844-5297
US

IV. Provider business mailing address

105 N 2ND ST APT 107
PHILADELPHIA PA
19106-2030
US

V. Phone/Fax

Practice location:
  • Phone: 908-938-6995
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03817900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: