Healthcare Provider Details

I. General information

NPI: 1174171292
Provider Name (Legal Business Name): YUSHAN LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2019
Last Update Date: 12/09/2020
Certification Date: 12/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4024 COLLEGE POINT BLVD
FLUSHING NY
11354-5111
US

IV. Provider business mailing address

4024 COLLEGE POINT BLVD
FLUSHING NY
11354-5111
US

V. Phone/Fax

Practice location:
  • Phone: 347-532-9943
  • Fax: 327-532-9944
Mailing address:
  • Phone: 347-532-9943
  • Fax: 327-532-9944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number065938
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: