Provider Demographics
NPI:1952580375
Name:LU, LINDA M (RPH)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:LU
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 1:13347 SANFORD AVE STE C1D
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5816
Mailing Address - Country:US
Mailing Address - Phone:718-460-8329
Mailing Address - Fax:
Practice Address - Street 1:13347 SANFORD AVE STE C1D
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5816
Practice Address - Country:US
Practice Address - Phone:718-460-8329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044157183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist