Provider Demographics
NPI:1932495843
Name:LIEU, DAN CHAN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:CHAN
Last Name:LIEU
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 MANNHEIM RD
Mailing Address - Street 2:1342
Mailing Address - City:ROSEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60018-3621
Mailing Address - Country:US
Mailing Address - Phone:847-795-1878
Mailing Address - Fax:847-795-1878
Practice Address - Street 1:7000 MANNHEIM RD
Practice Address - Street 2:1342
Practice Address - City:ROSEMONT
Practice Address - State:IL
Practice Address - Zip Code:60018-3621
Practice Address - Country:US
Practice Address - Phone:847-795-1878
Practice Address - Fax:847-795-1878
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.037389183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist