Provider Demographics
NPI:1437433026
Name:LU, QUYEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:QUYEN
Middle Name:
Last Name:LU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 PACIFIC BLVD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-2923
Mailing Address - Country:US
Mailing Address - Phone:323-826-9775
Mailing Address - Fax:323-826-9583
Practice Address - Street 1:6100 PACIFIC BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-2923
Practice Address - Country:US
Practice Address - Phone:323-826-9775
Practice Address - Fax:323-826-9583
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47344183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist