Provider Demographics
NPI:1932819463
Name:TAKWA, LUBNA (RPH)
Entity Type:Individual
Prefix:
First Name:LUBNA
Middle Name:
Last Name:TAKWA
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 1:8327 LABONT WAY
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-4425
Mailing Address - Country:US
Mailing Address - Phone:714-854-4675
Mailing Address - Fax:
Practice Address - Street 1:16395 WAGNER WAY
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5754
Practice Address - Country:US
Practice Address - Phone:952-937-2934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN125879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist