Provider Demographics
NPI:1255680237
Name:LIU, ANGELA TAMAE
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:TAMAE
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 1:2727 N MAIZE RD
Mailing Address - Street 2:T-1945
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-7311
Mailing Address - Country:US
Mailing Address - Phone:316-729-2798
Mailing Address - Fax:
Practice Address - Street 1:2727 N MAIZE RD
Practice Address - Street 2:T-1945
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-7311
Practice Address - Country:US
Practice Address - Phone:316-729-2798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-15308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist