Healthcare Provider Details

I. General information

NPI: 1437873858
Provider Name (Legal Business Name): FREDERICK LIU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 LOCKBOURNE RD
COLUMBUS OH
43206-3736
US

IV. Provider business mailing address

6560 SCHENK AVE
REYNOLDSBURG OH
43068-1044
US

V. Phone/Fax

Practice location:
  • Phone: 614-449-9771
  • Fax:
Mailing address:
  • Phone: 614-402-9770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03219716
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: