Provider Demographics
NPI:1447962543
Name:LIU, MICHELLE HUE-YAN
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:HUE-YAN
Last Name:LIU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2069 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2803
Mailing Address - Country:US
Mailing Address - Phone:212-799-1067
Mailing Address - Fax:
Practice Address - Street 1:2069 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2803
Practice Address - Country:US
Practice Address - Phone:212-799-1067
Practice Address - Fax:212-799-2059
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-20
Last Update Date:2023-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070004183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist