MEDICARE: SUETPING LAU PHARM.D.

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	051155	NY

General Provider Information

NPI Number	:	1447418777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUETPING LAU PHARM.D.

Provider Business Mailing Address
First Line	:	5427 VALLES AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10471-2504
Country	:	US
Telephone Number	:	646-508-6288
Fax Number	:

Provider Business Practice Location Address
First Line	:	5427 VALLES AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10471-2504
Country	:	US
Telephone Number	:	646-508-6288
Fax Number	:

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

Provider Enumeration Date	:	05/22/2008
Last Update Date	:	05/22/2008

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