Provider Demographics
NPI:1144595893
Name:LAU, ALICE S (RPH)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:S
Last Name:LAU
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:802 134TH ST SW BLDG C
Mailing Address - Street 2:STE 140
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-7314
Mailing Address - Country:US
Mailing Address - Phone:800-607-6861
Mailing Address - Fax:800-633-0334
Practice Address - Street 1:802 134TH ST SW BLDG C
Practice Address - Street 2:STE 140
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-7314
Practice Address - Country:US
Practice Address - Phone:800-607-6861
Practice Address - Fax:800-633-0334
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00042471183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist