Healthcare Provider Details

I. General information

NPI: 1659962850
Provider Name (Legal Business Name): ZHONGYANG LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2021
Last Update Date: 01/30/2021
Certification Date: 01/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 N MACDADE BLVD
GLENOLDEN PA
19036-1302
US

IV. Provider business mailing address

3500 TUDOR ST
PHILADELPHIA PA
19136-3815
US

V. Phone/Fax

Practice location:
  • Phone: 610-522-0600
  • Fax:
Mailing address:
  • Phone: 917-660-1031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP455142
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: