Healthcare Provider Details

I. General information

NPI: 1568309078
Provider Name (Legal Business Name): BRANDON LAU
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 N BROADWAY ST
CHICAGO IL
60657-3514
US

IV. Provider business mailing address

1459 W OLIVE AVE
CHICAGO IL
60660-4228
US

V. Phone/Fax

Practice location:
  • Phone: 773-327-3591
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.308358
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: