Provider Demographics
NPI:1306466719
Name:LAMDAN, GRIGORIY (RPH, PHARMD)
Entity type:Individual
Prefix:
First Name:GRIGORIY
Middle Name:
Last Name:LAMDAN
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 174TH ST APT 1403
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3235
Mailing Address - Country:US
Mailing Address - Phone:305-894-6774
Mailing Address - Fax:
Practice Address - Street 1:301 174TH ST APT 1403
Practice Address - Street 2:
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-3235
Practice Address - Country:US
Practice Address - Phone:305-894-6774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-26
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL36114183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist