Healthcare Provider Details

I. General information

NPI: 1326875857
Provider Name (Legal Business Name): JENNIFER LIU PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W 10TH AVE 368 DOAN HALL
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

410 W 10TH AVE 368 DOAN HALL
COLUMBUS OH
43210-1240
US

V. Phone/Fax

Practice location:
  • Phone: 614-685-0042
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH88008
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051304791
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code1835I0206X
TaxonomyInfectious Diseases Pharmacist
License Number03444798
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: