Provider Demographics
NPI:1063789675
Name:LAU, FERNANDO TONY (PHARMD)
Entity type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:TONY
Last Name:LAU
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 WILLOW PASS RD
Mailing Address - Street 2:
Mailing Address - City:BAY POINT
Mailing Address - State:CA
Mailing Address - Zip Code:94565-6603
Mailing Address - Country:US
Mailing Address - Phone:925-709-0317
Mailing Address - Fax:
Practice Address - Street 1:2700 WILLOW PASS RD
Practice Address - Street 2:
Practice Address - City:BAY POINT
Practice Address - State:CA
Practice Address - Zip Code:94565-6603
Practice Address - Country:US
Practice Address - Phone:925-709-0317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-27
Last Update Date:2011-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 59589183500000X
FLPS 42474183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist