Provider Demographics
NPI:1346948775
Name:LAM, NGOC DIEU T
Entity Type:Individual
Prefix:
First Name:NGOC DIEU
Middle Name:T
Last Name:LAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 DIXIE DR
Mailing Address - Street 2:
Mailing Address - City:CLUTE
Mailing Address - State:TX
Mailing Address - Zip Code:77531-5147
Mailing Address - Country:US
Mailing Address - Phone:979-265-2517
Mailing Address - Fax:
Practice Address - Street 1:51 DIXIE DR
Practice Address - Street 2:
Practice Address - City:CLUTE
Practice Address - State:TX
Practice Address - Zip Code:77531-5147
Practice Address - Country:US
Practice Address - Phone:979-265-2517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71853183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist