Provider Demographics
NPI:1578150678
Name:LIAN, HENRY
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:LIAN
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 1:219 MADISON ST APT 7
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-7571
Mailing Address - Country:US
Mailing Address - Phone:646-684-8649
Mailing Address - Fax:
Practice Address - Street 1:219 MADISON ST APT 7
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-7571
Practice Address - Country:US
Practice Address - Phone:646-684-8649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067342183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist