Provider Demographics
NPI:1528435518
Name:LIEU, JOHN TAN (PHARMD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:TAN
Last Name:LIEU
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3870 N DRUID HILLS RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3002
Mailing Address - Country:US
Mailing Address - Phone:404-633-6466
Mailing Address - Fax:
Practice Address - Street 1:3870 N DRUID HILLS RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3002
Practice Address - Country:US
Practice Address - Phone:404-633-6466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028784183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist