Healthcare Provider Details

I. General information

NPI: 1215744370
Provider Name (Legal Business Name): JENNY LIU PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16912 35TH AVE
FLUSHING NY
11358-1816
US

IV. Provider business mailing address

16912 35TH AVE
FLUSHING NY
11358-1816
US

V. Phone/Fax

Practice location:
  • Phone: 718-799-0492
  • Fax:
Mailing address:
  • Phone: 718-799-0492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number072269
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: