Healthcare Provider Details

I. General information

NPI: 1023595733
Provider Name (Legal Business Name): MENGQIAN ZHU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 VETERANS DR
LEXINGTON KY
40502-2235
US

IV. Provider business mailing address

2545 SUNGALE CT
LEXINGTON KY
40513-1480
US

V. Phone/Fax

Practice location:
  • Phone: 859-576-4991
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number019933
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: