Provider Demographics
NPI:1558797803
Name:LAI, ERIC (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:LAI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 BROADWAY FRNT A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-2798
Mailing Address - Country:US
Mailing Address - Phone:646-927-5325
Mailing Address - Fax:646-927-5326
Practice Address - Street 1:415 BROADWAY FRNT A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-2798
Practice Address - Country:US
Practice Address - Phone:646-927-5325
Practice Address - Fax:646-927-5326
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058631183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist