Provider Demographics
NPI:1376814327
Name:HSU, TAU H
Entity Type:Individual
Prefix:MR
First Name:TAU
Middle Name:H
Last Name:HSU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1107
Mailing Address - Country:US
Mailing Address - Phone:781-622-3894
Mailing Address - Fax:781-890-5630
Practice Address - Street 1:71 2ND AVE
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1107
Practice Address - Country:US
Practice Address - Phone:781-622-3894
Practice Address - Fax:781-890-5630
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22807183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist