Healthcare Provider Details

I. General information

NPI: 1972323343
Provider Name (Legal Business Name): ANTONG LIU PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 11/24/2024
Certification Date: 11/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 MANHATTAN AVE
BROOKLYN NY
11222-2508
US

IV. Provider business mailing address

859 MANHATTAN AVE
BROOKLYN NY
11222-2508
US

V. Phone/Fax

Practice location:
  • Phone: 718-389-2403
  • Fax:
Mailing address:
  • Phone: 718-389-2403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number071942
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: