Provider Demographics
NPI:1295371300
Name:LUU, SON NGOC (PHARMD)
Entity type:Individual
Prefix:
First Name:SON
Middle Name:NGOC
Last Name:LUU
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:SON
Other - Middle Name:NGOC
Other - Last Name:LUU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHAMD
Mailing Address - Street 1:5041 BARSTOW STREET
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117
Mailing Address - Country:US
Mailing Address - Phone:858-610-0647
Mailing Address - Fax:
Practice Address - Street 1:1792 GARNET AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-3350
Practice Address - Country:US
Practice Address - Phone:858-483-1489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-24
Last Update Date:2019-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55932183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist