Provider Demographics
NPI:1932813698
Name:VU, VIVIAN THU (PHARMD)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:THU
Last Name:VU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13847 REMBRANDT WAY
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-3258
Mailing Address - Country:US
Mailing Address - Phone:703-473-4055
Mailing Address - Fax:
Practice Address - Street 1:5727 BURKE CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-2204
Practice Address - Country:US
Practice Address - Phone:703-323-8784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202220793183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202220793OtherVIRGINIA PHARMACY LICENSE