Provider Demographics
NPI:1871875658
Name:JIN, LU
Entity type:Individual
Prefix:MS
First Name:LU
Middle Name:
Last Name:JIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BRENDAN RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01510-1344
Mailing Address - Country:US
Mailing Address - Phone:978-706-1588
Mailing Address - Fax:
Practice Address - Street 1:720 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MA
Practice Address - Zip Code:01510-2430
Practice Address - Country:US
Practice Address - Phone:978-368-3484
Practice Address - Fax:978-368-9029
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH25599183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist