Healthcare Provider Details

I. General information

NPI: 1710362884
Provider Name (Legal Business Name): DEREK MICHAEL LIU PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S COLUMBIAN WAY S-119-PHARMACY
SEATTLE WA
98108-1532
US

IV. Provider business mailing address

1301 HARBOR AVE SW APT 212
SEATTLE WA
98116-1763
US

V. Phone/Fax

Practice location:
  • Phone: 206-277-1963
  • Fax:
Mailing address:
  • Phone: 954-895-9081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.298659
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: