Provider Demographics
NPI:1316542327
Name:LIEU, CINDY MARY (PHARMD)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:MARY
Last Name:LIEU
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 1:3019 LAWSON DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-6419
Mailing Address - Country:US
Mailing Address - Phone:404-428-0579
Mailing Address - Fax:
Practice Address - Street 1:140 WOODSTOCK SQUARE AVE
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-6500
Practice Address - Country:US
Practice Address - Phone:770-517-5619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH031158183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist