Provider Demographics
NPI:1366670317
Name:LAM, PHIEU (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:PHIEU
Middle Name:
Last Name:LAM
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6540 STOCKTON BLVD STE 3B
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-1635
Mailing Address - Country:US
Mailing Address - Phone:916-422-5675
Mailing Address - Fax:916-422-9864
Practice Address - Street 1:6540 STOCKTON BLVD STE 3B
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-1635
Practice Address - Country:US
Practice Address - Phone:916-422-5675
Practice Address - Fax:916-422-9864
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY42189183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA421890Medicaid