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General NPI Number Information
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NPI Number | 1508429440
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Entity Type | Individual
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Provider Name | JEREMY LIU
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Gender | Male
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Dates
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Enumeration Date | 04/16/2019
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Last Update Date | 09/01/2020
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Provider Practice Location Address
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Address Line | 13800 VETERANS WAY
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City | ORLANDO
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State | FL
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Zip | 32827-7401
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Country | US
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Telephone | 732-853-9584
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Fax |
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Provider Business Mailing Address
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Address Line | 26 VILLAGE RD
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City | KENDALL PARK
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State | NJ
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Zip | 08824-1546
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Country | US
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Telephone | 732-940-6606
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Fax |
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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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 28RI03988200
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License Number State | NJ
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