Provider Demographics
NPI:1043351554
Name:LAI, GRACE I (RPH)
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:
Last Name:LAI
Suffix:I
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 HARRIS RD
Mailing Address - Street 2:UNIT CB-1
Mailing Address - City:BEDFORD HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10507-2125
Mailing Address - Country:US
Mailing Address - Phone:914-241-2747
Mailing Address - Fax:914-241-2747
Practice Address - Street 1:25 OLD TAPPAN RD
Practice Address - Street 2:
Practice Address - City:TAPPAN
Practice Address - State:NY
Practice Address - Zip Code:10983-2420
Practice Address - Country:US
Practice Address - Phone:845-359-1777
Practice Address - Fax:845-359-2471
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist