Provider Demographics
NPI:1487646071
Name:LIQUA, MICHAEL J (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:LIQUA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 WEATHERSTONE CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-6822
Mailing Address - Country:US
Mailing Address - Phone:678-642-2221
Mailing Address - Fax:
Practice Address - Street 1:520 WEATHERSTONE CT
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-6822
Practice Address - Country:US
Practice Address - Phone:678-642-2221
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2021-08-03
Deactivation Date:2011-08-09
Deactivation Code:
Reactivation Date:2021-08-03
Provider Licenses
StateLicense IDTaxonomies
GARPH019125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist