Provider Demographics
NPI:1720372915
Name:LUU, LEE DERIC (PHARM D)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:DERIC
Last Name:LUU
Suffix:
Gender:M
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 1:1970 CASTLEGATE LN
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-1636
Mailing Address - Country:US
Mailing Address - Phone:909-991-9281
Mailing Address - Fax:
Practice Address - Street 1:16964 SLOVER AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92337-7556
Practice Address - Country:US
Practice Address - Phone:909-356-0540
Practice Address - Fax:909-356-0540
Is Sole Proprietor?:No
Enumeration Date:2011-06-05
Last Update Date:2011-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61674183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist