Provider Demographics
NPI:1417348715
Name:LIEN, ANDREW VAN
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:VAN
Last Name:LIEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3637 EUREKA WAY
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0177
Mailing Address - Country:US
Mailing Address - Phone:530-768-1319
Mailing Address - Fax:530-768-1321
Practice Address - Street 1:3637 EUREKA WAY
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0177
Practice Address - Country:US
Practice Address - Phone:530-768-1319
Practice Address - Fax:530-768-1321
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45002183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist