Provider Demographics
NPI:1134413255
Name:LAU, KENNETH TINCHI (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:TINCHI
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 1:312 MULLICA HILL RD
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-1204
Mailing Address - Country:US
Mailing Address - Phone:856-863-1129
Mailing Address - Fax:
Practice Address - Street 1:245 FRIES MILL RD
Practice Address - Street 2:SUITE A
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-2059
Practice Address - Country:US
Practice Address - Phone:856-374-4066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03372100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist