Basic Information
| Provider Information | |||||||||
| NPI: | 1588116081 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUU | ||||||||
| FirstName: | LE | ||||||||
| MiddleName: | NGOC | ||||||||
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| Credential: | PHARM.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30114 MICKELSON WAY | ||||||||
| Address2: | |||||||||
| City: | MURRIETA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925637608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144690530 | ||||||||
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| Practice Location | |||||||||
| Address1: | 28400 MCCALL BLVD | ||||||||
| Address2: | |||||||||
| City: | MENIFEE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925859658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516798888 | ||||||||
| FaxNumber: | 9516727095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2016 | ||||||||
| LastUpdateDate: | 10/31/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 11058 | NV | N | Pharmacy Service Providers | Pharmacist | 1835P0018X | 44822 | CA | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.