Provider Demographics
NPI:1699097493
Name:LIU, KE HUA (RPH)
Entity type:Individual
Prefix:MR
First Name:KE HUA
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2842
Mailing Address - Country:US
Mailing Address - Phone:631-858-0408
Mailing Address - Fax:631-858-0504
Practice Address - Street 1:5001 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2842
Practice Address - Country:US
Practice Address - Phone:631-858-0408
Practice Address - Fax:631-858-0504
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-20
Last Update Date:2010-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046805183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist