Healthcare Provider Details

I. General information

NPI: 1689558959
Provider Name (Legal Business Name): WINNIE LAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 08/01/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 W VALLEY BLVD UNIT 7
ALHAMBRA CA
91803-3359
US

IV. Provider business mailing address

517 E MISSION RD
SAN GABRIEL CA
91776-2826
US

V. Phone/Fax

Practice location:
  • Phone: 833-532-5744
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number89225
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: