Provider Demographics
NPI:1619320488
Name:LU, RYAN L (PHARMD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:L
Last Name:LU
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 1:2700 S NC 127 HWY
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-9130
Mailing Address - Country:US
Mailing Address - Phone:828-294-0058
Mailing Address - Fax:
Practice Address - Street 1:2700 S NC 127 HWY
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-9130
Practice Address - Country:US
Practice Address - Phone:828-294-0058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25925183500000X
NJ28RI03749500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist