Provider Demographics
NPI:1114204617
Name:LIANG, JIMMY C (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:C
Last Name:LIANG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:CHUN MING
Other - Middle Name:
Other - Last Name:LIANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:360 E SOUTH WATER ST
Mailing Address - Street 2:#3502
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-4028
Mailing Address - Country:US
Mailing Address - Phone:469-569-2755
Mailing Address - Fax:
Practice Address - Street 1:3405 S M L KING DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-4108
Practice Address - Country:US
Practice Address - Phone:312-326-4058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051293799183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist