Provider Demographics
NPI:1528601390
Name:LAHAI, GASSUMU
Entity Type:Individual
Prefix:MR
First Name:GASSUMU
Middle Name:
Last Name:LAHAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 KINGSLEY DR APT 7105
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4122
Mailing Address - Country:US
Mailing Address - Phone:470-583-4010
Mailing Address - Fax:
Practice Address - Street 1:2101 KINGSLEY DR APT 7105
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-4122
Practice Address - Country:US
Practice Address - Phone:470-583-4010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60129183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX833534772OtherCONSULTING