MEDICARE: DR. RICKEY 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	051.294916	IL

General Provider Information

NPI Number	:	1356622831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICKEY LAU

Provider Business Mailing Address
First Line	:	2502 W 40TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-1110
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1926 W 35TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-1204
Country	:	US
Telephone Number	:	773-254-5523
Fax Number	:

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

Provider Enumeration Date	:	08/29/2011
Last Update Date	:	08/29/2011

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Directions to “ DR. RICKEY LAU ” Practice Location

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