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General NPI Number Information
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NPI Number | 1124780804
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Entity Type | Individual
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Provider Name | BRIAN LU PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/09/2021
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Last Update Date | 10/20/2021
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Provider Practice Location Address
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Address Line | 2931 S FISH HATCHERY RD
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City | FITCHBURG
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State | WI
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Zip | 53711-6499
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Country | US
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Telephone | 608-277-0087
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Fax |
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Provider Business Mailing Address
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Address Line | 6322 ELMWOOD AVE
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City | MIDDLETON
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State | WI
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Zip | 53562-3301
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Country | US
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Telephone | 626-590-6832
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 21158-40
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 21158-40
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License Number State | WI
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