Provider Demographics
NPI:1376929422
Name:VU, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:VU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11900 BLUERIDGE CT
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-1098
Mailing Address - Country:US
Mailing Address - Phone:405-371-9313
Mailing Address - Fax:
Practice Address - Street 1:1419 COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:MOUNDS
Practice Address - State:OK
Practice Address - Zip Code:74047
Practice Address - Country:US
Practice Address - Phone:918-827-6301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist