Provider Demographics
NPI:1033570395
Name:LAU, PHILLIP (RPH)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:LAU
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 GREAT RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:MA
Mailing Address - Zip Code:01775-2150
Mailing Address - Country:US
Mailing Address - Phone:978-897-1736
Mailing Address - Fax:978-897-5382
Practice Address - Street 1:155 GREAT RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:MA
Practice Address - Zip Code:01775-2150
Practice Address - Country:US
Practice Address - Phone:978-897-1736
Practice Address - Fax:978-897-5382
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH24844183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist