Provider Demographics
NPI:1619572815
Name:KU, LAWRENCE CHING-CHAO (RPH)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:CHING-CHAO
Last Name:KU
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:CHING-CHAO
Other - Middle Name:LAWRENCE
Other - Last Name:KU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1731 FINLAND PALM
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-2600
Mailing Address - Country:US
Mailing Address - Phone:915-241-1410
Mailing Address - Fax:
Practice Address - Street 1:1731 FINLAND PALM
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-2600
Practice Address - Country:US
Practice Address - Phone:915-241-1410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31778183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist