MEDICARE: TIANNING LIU PHARM.D

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	S021658	AZ

General Provider Information

NPI Number	:	1366814014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIANNING LIU PHARM.D

Provider Business Mailing Address
First Line	:	4744 S HIGHWAY 95
Second Line	:
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-9377
Country	:	US
Telephone Number	:	928-763-6822
Fax Number	:	928-763-6817

Provider Business Practice Location Address
First Line	:	4744 S HIGHWAY 95
Second Line	:
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-9377
Country	:	US
Telephone Number	:	928-763-6822
Fax Number	:	928-763-6817

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

Provider Enumeration Date	:	10/21/2015
Last Update Date	:	10/21/2015

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