Provider Demographics
NPI:1093035651
Name:LAI, PAULINE P (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:PAULINE
Middle Name:P
Last Name:LAI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 VICTORIA AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041-2141
Mailing Address - Country:US
Mailing Address - Phone:805-985-2326
Mailing Address - Fax:805-984-0882
Practice Address - Street 1:2480 VICTORIA AVE
Practice Address - Street 2:
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93041-2141
Practice Address - Country:US
Practice Address - Phone:805-985-2326
Practice Address - Fax:805-984-0882
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH49635183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist