Provider Demographics
NPI:1952624280
Name:LAU, WAI LOI (RPH)
Entity Type:Individual
Prefix:
First Name:WAI
Middle Name:LOI
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 1:440 E 138TH ST # 3/4
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-3026
Mailing Address - Country:US
Mailing Address - Phone:718-401-7375
Mailing Address - Fax:718-401-7375
Practice Address - Street 1:440 E 138TH ST
Practice Address - Street 2:#3/4
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-3026
Practice Address - Country:US
Practice Address - Phone:718-401-7375
Practice Address - Fax:718-401-7375
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0382841835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY27Medicaid
NY18Medicaid