Provider Demographics
NPI:1598006058
Name:LAI, DEXTER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEXTER
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 1:5006 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-3302
Mailing Address - Country:US
Mailing Address - Phone:215-748-1000
Mailing Address - Fax:215-748-4715
Practice Address - Street 1:5006 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-3302
Practice Address - Country:US
Practice Address - Phone:215-748-1000
Practice Address - Fax:215-748-4715
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP445028183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist