Healthcare Provider Details

I. General information

NPI: 1609547645
Provider Name (Legal Business Name): AMY LIU RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6910 3RD AVE
BROOKLYN NY
11209-1305
US

IV. Provider business mailing address

46D PEARSALL ST
STATEN ISLAND NY
10305-4218
US

V. Phone/Fax

Practice location:
  • Phone: 718-680-2229
  • Fax:
Mailing address:
  • Phone: 718-755-4588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number068214
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: