Provider Demographics
NPI:1962176768
Name:LIU, JENNY (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:LIU
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 1:1715 S HIDALGO AVE
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-5541
Mailing Address - Country:US
Mailing Address - Phone:626-274-0853
Mailing Address - Fax:
Practice Address - Street 1:1220 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-2819
Practice Address - Country:US
Practice Address - Phone:626-812-6470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84612183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist