MEDICARE: LIEN GOVERNANTI 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	55096	CA

General Provider Information

NPI Number	:	1568730182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIEN GOVERNANTI PHARM.D.

Provider Business Mailing Address
First Line	:	1931 N CAMPUS AVE
Second Line	:	T-1834
City	:	UPLAND
State	:	CA
Zip	:	91784-1667
Country	:	US
Telephone Number	:	909-981-6428
Fax Number	:	909-981-6428

Provider Business Practice Location Address
First Line	:	1931 N CAMPUS AVE
Second Line	:	T-1834
City	:	UPLAND
State	:	CA
Zip	:	91784-1667
Country	:	US
Telephone Number	:	909-981-6428
Fax Number	:	909-981-6428

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

Provider Enumeration Date	:	12/09/2011
Last Update Date	:	12/09/2011

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