Provider Demographics
NPI:1255524112
Name:LAU, JEANETTE (PHARMD)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:LAU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 W FOUNTAINHEAD PKWY STE 295
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1869
Mailing Address - Country:US
Mailing Address - Phone:866-495-6738
Mailing Address - Fax:
Practice Address - Street 1:1501 W FOUNTAINHEAD PKWY STE 295
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1869
Practice Address - Country:US
Practice Address - Phone:866-495-6738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0111851835P1300X
CA543471835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric