Provider Demographics
NPI:1417261504
Name:LU, WEN
Entity Type:Individual
Prefix:
First Name:WEN
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 1:11 BETSY ROSS CT APT C
Mailing Address - Street 2:
Mailing Address - City:BOUND BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08805-1192
Mailing Address - Country:US
Mailing Address - Phone:908-766-7920
Mailing Address - Fax:908-766-1947
Practice Address - Street 1:16 LYONS MALL
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-1928
Practice Address - Country:US
Practice Address - Phone:908-766-7920
Practice Address - Fax:908-766-1947
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2010-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03119300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist