Provider Demographics
NPI:1912160011
Name:LIAO, WEI WEI (PHARMD)
Entity Type:Individual
Prefix:
First Name:WEI WEI
Middle Name:
Last Name:LIAO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20510 DIVONNE DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2437
Mailing Address - Country:US
Mailing Address - Phone:909-720-6525
Mailing Address - Fax:
Practice Address - Street 1:861 N HACIENDA BLVD
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-2809
Practice Address - Country:US
Practice Address - Phone:626-968-0669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59993183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist