Provider Demographics
NPI:1033496393
Name:MOY, LAI FONG (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAI
Middle Name:FONG
Last Name:MOY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LILY
Other - Middle Name:
Other - Last Name:MOY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3201 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-5001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3201 W 6TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-5001
Practice Address - Country:US
Practice Address - Phone:213-251-0179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH61130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist