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General NPI Number Information
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NPI Number | 1053746677
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Entity Type | Individual
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Provider Name | SIAM LIEU PHARMD
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Gender | Male
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Dates
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Enumeration Date | 09/13/2013
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Last Update Date | 09/13/2013
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Provider Practice Location Address
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Address Line | 1090 SPIRIT LAKE RD
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City | WINTER HAVEN
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State | FL
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Zip | 33880-1226
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Country | US
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Telephone | 863-293-5007
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Fax | 863-291-8544
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Provider Business Mailing Address
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Address Line | 1090 SPIRIT LAKE RD
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City | WINTER HAVEN
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State | FL
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Zip | 33880
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Country | US
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Telephone | 863-291-5007
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Fax | 863-291-8544
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS50507
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License Number State | FL
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