Provider Demographics
NPI:1275134306
Name:LAI, RYAN (RPH)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:LAI
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 1:2101 STEPTOE ST APT 146
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-8554
Mailing Address - Country:US
Mailing Address - Phone:626-632-2155
Mailing Address - Fax:
Practice Address - Street 1:2005 W COURT ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-3934
Practice Address - Country:US
Practice Address - Phone:509-545-4391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61015593183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist