Provider Demographics
NPI:1548865322
Name:CHERIAN, LIJU JACOB
Entity type:Individual
Prefix:
First Name:LIJU
Middle Name:JACOB
Last Name:CHERIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 HOLLYBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-5747
Mailing Address - Country:US
Mailing Address - Phone:215-354-7508
Mailing Address - Fax:
Practice Address - Street 1:180 LEVITTOWN PKWY
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19055-2456
Practice Address - Country:US
Practice Address - Phone:215-949-6605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP446644183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist