Basic Information
| Provider Information | |||||||||
| NPI: | 1295281533 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIU | ||||||||
| FirstName: | WENLI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1560 HIGHWAY 56 | ||||||||
| Address2: | |||||||||
| City: | CREEDMOOR | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27522 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1560 HIGHWAY 56 | ||||||||
| Address2: | |||||||||
| City: | CREEDMOOR | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195281538 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2016 | ||||||||
| LastUpdateDate: | 08/28/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 26242 | NC | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.