Provider Demographics
NPI:1942633672
Name:LIEN, JONATHAN STEVEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:STEVEN
Last Name:LIEN
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 1:2902 210TH PL
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2433
Mailing Address - Country:US
Mailing Address - Phone:917-579-3478
Mailing Address - Fax:
Practice Address - Street 1:2501 30TH AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-2447
Practice Address - Country:US
Practice Address - Phone:718-278-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058458183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist