Provider Demographics
NPI:1689900599
Name:WU, BRIAN PAK (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:PAK
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 1:655 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-2801
Mailing Address - Country:US
Mailing Address - Phone:213-617-7888
Mailing Address - Fax:213-617-7241
Practice Address - Street 1:655 N BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2801
Practice Address - Country:US
Practice Address - Phone:213-617-7888
Practice Address - Fax:213-617-7241
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63152183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist