Provider Demographics
NPI:1023318979
Name:LAU, JASEN CHI-SING (CPHT)
Entity type:Individual
Prefix:
First Name:JASEN
Middle Name:CHI-SING
Last Name:LAU
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14939 SHADY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7719
Mailing Address - Country:US
Mailing Address - Phone:301-944-1585
Mailing Address - Fax:
Practice Address - Street 1:14939 SHADY GROVE RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-7719
Practice Address - Country:US
Practice Address - Phone:301-944-1585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT06649183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician