Provider Demographics
NPI:1457634859
Name:LAM, MAINA M (PHARM D)
Entity Type:Individual
Prefix:MISS
First Name:MAINA
Middle Name:M
Last Name:LAM
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3232 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-3113
Mailing Address - Country:US
Mailing Address - Phone:510-261-4552
Mailing Address - Fax:510-261-7604
Practice Address - Street 1:3232 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-3113
Practice Address - Country:US
Practice Address - Phone:510-261-4552
Practice Address - Fax:510-261-7604
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54664183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist