Healthcare Provider Details

I. General information

NPI: 1285019075
Provider Name (Legal Business Name): ANDREA LIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2015
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 W BIRCH ST
GLENROCK WY
82637-5079
US

IV. Provider business mailing address

PO BOX 786
GLENROCK WY
82637-0786
US

V. Phone/Fax

Practice location:
  • Phone: 307-436-7116
  • Fax: 307-436-3412
Mailing address:
  • Phone: 307-436-7116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3831
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: