MEDICARE: PHIL GUANG LIU

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	14951	NV

General Provider Information

NPI Number	:	1821629502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHIL GUANG LIU

Provider Business Mailing Address
First Line	:	4015 S BUFFALO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-7455
Country	:	US
Telephone Number	:	702-876-3215
Fax Number	:

Provider Business Practice Location Address
First Line	:	4015 S BUFFALO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-7455
Country	:	US
Telephone Number	:	702-876-3215
Fax Number	:

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

Provider Enumeration Date	:	01/30/2020
Last Update Date	:	01/30/2020

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Directions to “ PHIL GUANG LIU ” Practice Location

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