MEDICARE: MARISOL 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	PS 34791	FL

General Provider Information

NPI Number	:	1558781138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISOL LAU

Provider Business Mailing Address
First Line	:	13101 SW 29TH ST
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-3837
Country	:	US
Telephone Number	:	305-450-5029
Fax Number	:

Provider Business Practice Location Address
First Line	:	13101 SW 29TH ST
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-3837
Country	:	US
Telephone Number	:	305-450-5029
Fax Number	:

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

Provider Enumeration Date	:	04/22/2014
Last Update Date	:	04/22/2014

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Directions to “ MARISOL LAU ” Practice Location

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