Basic Information
| Provider Information | |||||||||
| NPI: | 1821315649 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAI | ||||||||
| FirstName: | PATRICK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11607 98TH AVE NE | ||||||||
| Address2: | |||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980344216 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 11607 98TH AVE NE | ||||||||
| Address2: | |||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980344216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258258841 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2010 | ||||||||
| LastUpdateDate: | 12/05/2015 | ||||||||
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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 | PH00061316 | WA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.