=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891043592
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUU DRUG STORES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2012
-----------------------------------------------------
Last Update Date | 11/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5805 RISING SUN AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19120-1125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-821-2883
-----------------------------------------------------
Fax | 215-821-2708
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3811 SCHOOL LN
-----------------------------------------------------
City | DREXEL HILL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19026-3113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-626-4549
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY OWNER
-----------------------------------------------------
Name | MISS TRUONG LUU
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 610-761-6625
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PP482298
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------