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General NPI Number Information
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NPI Number | 1003423898
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Entity Type | Individual
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Provider Name | MS. HALEY MAI-TRAM LUU
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Gender | Female
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Dates
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Enumeration Date | 09/25/2020
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Last Update Date | 09/28/2020
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Provider Practice Location Address
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Address Line | 1300 EDWARDS FERRY RD NE
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City | LEESBURG
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State | VA
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Zip | 20176-3355
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Country | US
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Telephone | 540-313-0822
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Fax |
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Provider Business Mailing Address
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Address Line | 44831 MILESTONE SQ APT 336
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City | ASHBURN
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State | VA
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Zip | 20147-4225
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Country | US
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Telephone | 540-313-0822
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 0230030285
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License Number State | VA
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