Provider Demographics
NPI:1124335989
Name:CHU, TERESA LAI SHAN
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:LAI SHAN
Last Name:CHU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17695 NE 122ND ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-2644
Mailing Address - Country:US
Mailing Address - Phone:206-226-3787
Mailing Address - Fax:
Practice Address - Street 1:18022 68TH AVE NE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-2400
Practice Address - Country:US
Practice Address - Phone:425-424-2320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00042261183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist