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General NPI Number Information
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NPI Number | 1194358093
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Entity Type | Individual
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Provider Name | MARK IAN LUA PHARMD
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Gender | Male
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Dates
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Enumeration Date | 02/19/2020
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Last Update Date | 02/19/2020
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Provider Practice Location Address
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Address Line | 3500 E PACIFIC COAST HWY
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City | LONG BEACH
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State | CA
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Zip | 90804-1904
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Country | US
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Telephone | 341-356-2494
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Fax |
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Provider Business Mailing Address
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Address Line | 22021 E SNOW CREEK DR
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City | WALNUT
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State | CA
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Zip | 91789-1496
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Country | US
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Telephone | 909-573-5218
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 82082
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License Number State | CA
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