Provider Demographics
NPI:1114204039
Name:LAU, ALICE T
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:T
Last Name:LAU
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 1:459 POWELL ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-1503
Mailing Address - Country:US
Mailing Address - Phone:415-984-0793
Mailing Address - Fax:415-984-0796
Practice Address - Street 1:459 POWELL ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-1503
Practice Address - Country:US
Practice Address - Phone:415-984-0793
Practice Address - Fax:415-984-0796
Is Sole Proprietor?:No
Enumeration Date:2011-11-06
Last Update Date:2011-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH36979183500000X
NV8619183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist