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General NPI Number Information
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NPI Number | 1326684424
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Entity Type | Individual
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Provider Name | WILL RUSSELL LIU
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Gender | Male
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Dates
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Enumeration Date | 11/23/2019
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Last Update Date | 11/23/2019
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Provider Practice Location Address
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Address Line | 5555 W ATLANTIC BLVD
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City | MARGATE
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State | FL
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Zip | 33063-5296
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Country | US
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Telephone | 954-975-5131
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Fax | 954-975-5568
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Provider Business Mailing Address
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Address Line | 5555 W ATLANTIC BLVD
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City | MARGATE
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State | FL
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Zip | 33063-5296
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Country | US
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Telephone | 954-975-5131
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Fax | 954-975-5568
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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 | PS37659
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License Number State | FL
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