Provider Demographics
NPI:1417249574
Name:LUU, FAUSTINE MAI (RPH)
Entity Type:Individual
Prefix:MRS
First Name:FAUSTINE
Middle Name:MAI
Last Name:LUU
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8403 133RD AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-1932
Mailing Address - Country:US
Mailing Address - Phone:718-326-3072
Mailing Address - Fax:718-326-3059
Practice Address - Street 1:7404 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-2637
Practice Address - Country:US
Practice Address - Phone:718-326-3072
Practice Address - Fax:718-302-3059
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042918183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist