Provider Demographics
NPI:1285918375
Name:NGUYEN, LIANA D (PHARMD)
Entity type:Individual
Prefix:MISS
First Name:LIANA
Middle Name:D
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 DRAPER ST # 1
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-1625
Mailing Address - Country:US
Mailing Address - Phone:857-222-4143
Mailing Address - Fax:
Practice Address - Street 1:56 DRAPER ST # 1
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-1625
Practice Address - Country:US
Practice Address - Phone:857-222-4143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH233694183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist