Provider Demographics
NPI:1447677869
Name:LIEU, NGUYEN-VAN
Entity type:Individual
Prefix:
First Name:NGUYEN-VAN
Middle Name:
Last Name:LIEU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:VAN
Other - Middle Name:
Other - Last Name:LIEU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4902 E FIRESTONE DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-7394
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4902 E FIRESTONE DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-7394
Practice Address - Country:US
Practice Address - Phone:480-298-4709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15026183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist