Provider Demographics
NPI:1841422953
Name:LAU, JOHNNY (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:
Last Name:LAU
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 E FORDHAM RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-5010
Mailing Address - Country:US
Mailing Address - Phone:718-220-2461
Mailing Address - Fax:718-220-2616
Practice Address - Street 1:406 E FORDHAM RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5010
Practice Address - Country:US
Practice Address - Phone:718-220-2461
Practice Address - Fax:718-220-2616
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-23
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051528183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist