Provider Demographics
NPI:1134358195
Name:LAU, NICHOLAS (RPH)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:
Last Name:LAU
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24370 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-2319
Mailing Address - Country:US
Mailing Address - Phone:917-541-4872
Mailing Address - Fax:
Practice Address - Street 1:10962 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11429-1753
Practice Address - Country:US
Practice Address - Phone:718-740-4612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0035611183500000X
NY048984-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist