Healthcare Provider Details

I. General information

NPI: 1609162866
Provider Name (Legal Business Name): STEPHANIE LUE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9725 LAUREL CANYON BLVD
ARLETA CA
91331-4100
US

IV. Provider business mailing address

1712 N VALLEY ST
BURBANK CA
91505-1715
US

V. Phone/Fax

Practice location:
  • Phone: 818-492-0025
  • Fax:
Mailing address:
  • Phone: 818-585-8750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH45008
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: