Provider Demographics
NPI:1447617121
Name:LAM, KHANG (RPH)
Entity Type:Individual
Prefix:
First Name:KHANG
Middle Name:
Last Name:LAM
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 1:6709 BLUEBELL DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-6718
Mailing Address - Country:US
Mailing Address - Phone:469-487-4963
Mailing Address - Fax:
Practice Address - Street 1:220 N HIGHWAY 175
Practice Address - Street 2:
Practice Address - City:SEAGOVILLE
Practice Address - State:TX
Practice Address - Zip Code:75159-1841
Practice Address - Country:US
Practice Address - Phone:972-287-2914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74194183500000X
TX51781183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist