Provider Demographics
NPI:1679841852
Name:LIEM, MARY (PHARM D)
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:
Last Name:LIEM
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 COMMERCE WAY
Mailing Address - Street 2:
Mailing Address - City:SEEKONK
Mailing Address - State:MA
Mailing Address - Zip Code:02771-5816
Mailing Address - Country:US
Mailing Address - Phone:508-336-1107
Mailing Address - Fax:
Practice Address - Street 1:79 COMMERCE WAY
Practice Address - Street 2:
Practice Address - City:SEEKONK
Practice Address - State:MA
Practice Address - Zip Code:02771-5816
Practice Address - Country:US
Practice Address - Phone:508-336-1107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH27612183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist