Provider Demographics
NPI:1336492768
Name:LUC, MI XUAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MI
Middle Name:XUAN
Last Name:LUC
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MAYLEE
Other - Middle Name:XUAN
Other - Last Name:LUC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1135 116TH AVE NE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1135 116TH AVE NE STE 105
Practice Address - Street 2:SUITE 105
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4638
Practice Address - Country:US
Practice Address - Phone:425-453-1130
Practice Address - Fax:425-453-5985
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60288477183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist