Healthcare Provider Details

I. General information

NPI: 1174127930
Provider Name (Legal Business Name): SHARON LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 LAKEWOOD RD
TOMS RIVER NJ
08755-1929
US

IV. Provider business mailing address

12 STARLING RD
KENDALL PARK NJ
08824-1009
US

V. Phone/Fax

Practice location:
  • Phone: 732-942-9860
  • Fax:
Mailing address:
  • Phone: 732-647-6940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03818900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: