MEDICARE: SHELBY WAI LING LAU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	87861	CA

General Provider Information

NPI Number	:	1023706876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY WAI LING LAU

Provider Business Mailing Address
First Line	:	11526 WINDCREST LN APT 366
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-4268
Country	:	US
Telephone Number	:	415-269-9289
Fax Number	:

Provider Business Practice Location Address
First Line	:	1430 EASTLAKE PKWY
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91915-1926
Country	:	US
Telephone Number	:	619-591-7042
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2023
Last Update Date	:	04/28/2023

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Directions to “ SHELBY WAI LING LAU ” Practice Location

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