Provider Demographics
NPI:1639827116
Name:LAU, LAURIE A
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
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 1:50 E PUAINAKO ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-5243
Mailing Address - Country:US
Mailing Address - Phone:808-959-8700
Mailing Address - Fax:808-959-7559
Practice Address - Street 1:50 E PUAINAKO ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5243
Practice Address - Country:US
Practice Address - Phone:808-959-8700
Practice Address - Fax:808-959-7559
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician