Provider Demographics
NPI:1578238754
Name:LAW, WAY
Entity Type:Individual
Prefix:
First Name:WAY
Middle Name:
Last Name:LAW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:WEI
Other - Middle Name:
Other - Last Name:LUO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3343 S ORANGE BLOSSOM TRL
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-6565
Mailing Address - Country:US
Mailing Address - Phone:407-932-2605
Mailing Address - Fax:407-933-7672
Practice Address - Street 1:3343 S ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-6565
Practice Address - Country:US
Practice Address - Phone:407-932-2605
Practice Address - Fax:407-933-7672
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS62761183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist