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NPI Code Detail

MEDICARE: JESSICA PAN LIU PHARMD

MEDICARE: JESSICA PAN LIU PHARMD
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
1183500000XPharmacist123414MN

General Provider Information

NPI Number : 1740702562
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA PAN LIU PHARMD
Provider Business Mailing Address
First Line : 5428 LYNDALE AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55419-1718
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5428 LYNDALE AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55419-1718
Country : US
Telephone Number : 612-824-1121
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2017
Last Update Date : 07/13/2017

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Directions to “ JESSICA PAN LIU PHARMD” Practice Location

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