Provider Demographics
NPI:1861604803
Name:LUC, CAROL THOAI (PHARM D)
Entity type:Individual
Prefix:MISS
First Name:CAROL
Middle Name:THOAI
Last Name:LUC
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5932 STERLING OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-1785
Mailing Address - Country:US
Mailing Address - Phone:408-930-4673
Mailing Address - Fax:650-934-7698
Practice Address - Street 1:701 E EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2833
Practice Address - Country:US
Practice Address - Phone:650-934-7699
Practice Address - Fax:650-934-7698
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49556183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA49556OtherSTATE BOARD
CA48425OtherPHARMACY PERMIT