Basic Information
| Provider Information | |||||||||
| NPI: | 1073035135 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAM | ||||||||
| FirstName: | HOANG | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | PHARM.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9929 S 228TH PL | ||||||||
| Address2: | |||||||||
| City: | KENT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980312547 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 117 SW 160TH ST | ||||||||
| Address2: | |||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981663024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062422030 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2017 | ||||||||
| LastUpdateDate: | 07/11/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PH60754785 | WA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.