Provider Demographics
NPI:1508634643
Name:LIAO, GRACE YUNJING (PHARMD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:YUNJING
Last Name:LIAO
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 1:11 FIELDSTONE LN
Mailing Address - Street 2:
Mailing Address - City:NORTH BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01862-2146
Mailing Address - Country:US
Mailing Address - Phone:978-727-2398
Mailing Address - Fax:
Practice Address - Street 1:35 COMPUTER DR
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01832-1236
Practice Address - Country:US
Practice Address - Phone:978-377-9004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH241509183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist