Provider Demographics
NPI:1922412931
Name:BUI, QUE
Entity Type:Individual
Prefix:
First Name:QUE
Middle Name:
Last Name:BUI
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 1:2250 E CARSON ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3044
Mailing Address - Country:US
Mailing Address - Phone:562-490-0201
Mailing Address - Fax:562-492-9884
Practice Address - Street 1:2250 E CARSON ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3044
Practice Address - Country:US
Practice Address - Phone:562-490-0201
Practice Address - Fax:562-492-9884
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48295183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist