MEDICARE: THERESA A LIEN RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302045703	MI
2	333600000X	Pharmacy	79312	CA
3	183500000X	Pharmacist	03236461	OH

General Provider Information

NPI Number	:	1033633508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA A LIEN RPH

Provider Business Mailing Address
First Line	:	2244 COLLINGWOOD BLVD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43620-1147
Country	:	US
Telephone Number	:	567-318-3891
Fax Number	:	567-218-3399

Provider Business Practice Location Address
First Line	:	2244 COLLINGWOOD BLVD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43620-1147
Country	:	US
Telephone Number	:	567-318-3891
Fax Number	:	567-218-3399

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2017
Last Update Date	:	03/15/2022

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Directions to “ THERESA A LIEN RPH” Practice Location

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