Healthcare Provider Details

I. General information

NPI: 1841969938
Provider Name (Legal Business Name): TRACY LUU PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TRACY MY-KIM LUU

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12491 VALLEY VIEW ST
GARDEN GROVE CA
92845-2032
US

IV. Provider business mailing address

14581 ABINGTON CIR
WESTMINSTER CA
92683-5837
US

V. Phone/Fax

Practice location:
  • Phone: 714-894-9230
  • Fax:
Mailing address:
  • Phone: 714-386-2662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number85075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: