Provider Demographics
NPI:1942805742
Name:LUU, MY-LINH THUY
Entity Type:Individual
Prefix:DR
First Name:MY-LINH
Middle Name:THUY
Last Name:LUU
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 1:1100 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-1606
Mailing Address - Country:US
Mailing Address - Phone:617-541-4300
Mailing Address - Fax:617-541-4309
Practice Address - Street 1:1100 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02125-1606
Practice Address - Country:US
Practice Address - Phone:617-541-4300
Practice Address - Fax:617-541-4309
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH26046183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist