Provider Demographics
NPI:1295056778
Name:LUA, PEACHY U (RPH)
Entity type:Individual
Prefix:
First Name:PEACHY
Middle Name:U
Last Name:LUA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77932 COUNTRY CLUB DRIVE, SUITE 2-2
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211
Mailing Address - Country:US
Mailing Address - Phone:760-223-7188
Mailing Address - Fax:760-223-7187
Practice Address - Street 1:77932 COUNTRY CLUB DRIVE
Practice Address - Street 2:SUITE 2-2
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211
Practice Address - Country:US
Practice Address - Phone:760-360-6280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60913183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist