Provider Demographics
NPI:1811566920
Name:LUU, JUSTIN QUOC (PHARMD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:QUOC
Last Name:LUU
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 1:1321 151ST PL SE
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8267
Mailing Address - Country:US
Mailing Address - Phone:425-918-2115
Mailing Address - Fax:
Practice Address - Street 1:358 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2310
Practice Address - Country:US
Practice Address - Phone:509-684-1440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60961876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist