Provider Demographics
NPI:1407635279
Name:LU, QIANQIAN
Entity Type:Individual
Prefix:
First Name:QIANQIAN
Middle Name:
Last Name:LU
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 1:1710 KEMPTON ST SE UNIT 302
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-7506
Mailing Address - Country:US
Mailing Address - Phone:956-789-0626
Mailing Address - Fax:
Practice Address - Street 1:520 CLEVELAND AVE SE
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-3313
Practice Address - Country:US
Practice Address - Phone:360-943-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61459411183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist