Provider Demographics
NPI:1043660038
Name:LAMBIV, WANYU (RPH)
Entity Type:Individual
Prefix:DR
First Name:WANYU
Middle Name:
Last Name:LAMBIV
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2793 ATHENA DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2412
Mailing Address - Country:US
Mailing Address - Phone:313-675-4724
Mailing Address - Fax:989-731-4216
Practice Address - Street 1:419 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1859
Practice Address - Country:US
Practice Address - Phone:989-732-5220
Practice Address - Fax:989-731-4216
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042545183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist