Provider Demographics
NPI:1083066682
Name:WU, ALEXANDER (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:WU
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 1:2547 MAIN ST STE 105
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1935
Mailing Address - Country:US
Mailing Address - Phone:203-751-3961
Mailing Address - Fax:
Practice Address - Street 1:2547 MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1935
Practice Address - Country:US
Practice Address - Phone:203-751-3961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0013435183500000X
MAPH236734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist