Healthcare Provider Details

I. General information

NPI: 1467708925
Provider Name (Legal Business Name): DONG BING LIU PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 QUEENS WAY
CAMILLUS NY
13031-1727
US

IV. Provider business mailing address

PO BOX 1027
BUFFALO NY
14240-1027
US

V. Phone/Fax

Practice location:
  • Phone: 315-637-7903
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number054847
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: