Provider Demographics
NPI:1639780919
Name:LIU, RICHARD (PHARMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 ROXBORO RD NE APT 3401
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1692
Mailing Address - Country:US
Mailing Address - Phone:414-405-4080
Mailing Address - Fax:
Practice Address - Street 1:4000 DEKALB TECHNOLOGY PKWY STE 320
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30340-2764
Practice Address - Country:US
Practice Address - Phone:404-504-5599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH032251183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist