Provider Demographics
NPI:1679867816
Name:LAU, GERRY CHRISTOPHER (PHARMD)
Entity Type:Individual
Prefix:
First Name:GERRY
Middle Name:CHRISTOPHER
Last Name:LAU
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8304 N SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-2870
Mailing Address - Country:US
Mailing Address - Phone:608-770-6316
Mailing Address - Fax:
Practice Address - Street 1:2600 S 108TH ST
Practice Address - Street 2:T-2199
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-1926
Practice Address - Country:US
Practice Address - Phone:414-545-0385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14935-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist