Provider Demographics
NPI:1578164877
Name:LU, MARY (PHARM D)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:LU
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E SPRING CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-3023
Mailing Address - Country:US
Mailing Address - Phone:972-516-8525
Mailing Address - Fax:972-516-8526
Practice Address - Street 1:1200 E SPRING CREEK PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-3023
Practice Address - Country:US
Practice Address - Phone:972-516-8525
Practice Address - Fax:972-516-8526
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47180183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist