Provider Demographics
NPI:1477258374
Name:WU, BO (PHARMD)
Entity Type:Individual
Prefix:
First Name:BO
Middle Name:
Last Name:WU
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15819 NE LEARY WAY APT D138
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4330
Mailing Address - Country:US
Mailing Address - Phone:425-480-1125
Mailing Address - Fax:
Practice Address - Street 1:200 S 3RD ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2031
Practice Address - Country:US
Practice Address - Phone:425-226-0325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61395103183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist