Provider Demographics
NPI:1891301511
Name:LIAO, ANGELINA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANGELINA
Middle Name:
Last Name:LIAO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:
Other - Last Name:LIAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 BERGAMO
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5324
Mailing Address - Country:US
Mailing Address - Phone:949-878-0318
Mailing Address - Fax:
Practice Address - Street 1:740 W ALLUVIAL AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-5509
Practice Address - Country:US
Practice Address - Phone:559-432-9800
Practice Address - Fax:559-797-3543
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist