Provider Demographics
NPI:1912207606
Name:LAUSSU, MANUELLA IRMA
Entity Type:Individual
Prefix:
First Name:MANUELLA
Middle Name:IRMA
Last Name:LAUSSU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 W NAOMI AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7517
Mailing Address - Country:US
Mailing Address - Phone:626-446-9261
Mailing Address - Fax:626-446-6104
Practice Address - Street 1:745 W NAOMI AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7517
Practice Address - Country:US
Practice Address - Phone:626-446-9261
Practice Address - Fax:626-446-6104
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist