Provider Demographics
NPI: | 1619955689 |
---|---|
Name: | CHING LAM, COLLETTE KAR YUN (PHARMD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | COLLETTE |
Middle Name: | KAR YUN |
Last Name: | CHING LAM |
Suffix: | |
Gender: | F |
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: | 1 JARRETT WHITE RD |
Mailing Address - Street 2: | |
Mailing Address - City: | TRIPLER AMC |
Mailing Address - State: | HI |
Mailing Address - Zip Code: | 96859-5001 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 808-433-3360 |
Mailing Address - Fax: | 808-433-1558 |
Practice Address - Street 1: | 1 JARRETT WHITE RD |
Practice Address - Street 2: | TRIPLER ARMY MEDICAL CENTER |
Practice Address - City: | TRIPLER AMC |
Practice Address - State: | HI |
Practice Address - Zip Code: | 96859-5001 |
Practice Address - Country: | US |
Practice Address - Phone: | 808-433-2460 |
Practice Address - Fax: | 808-433-1558 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-01-09 |
Last Update Date: | 2021-05-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
HI | PH-2298 | 183500000X, 1835P0018X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 1835P0018X | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No | 183500000X | Pharmacy Service Providers | Pharmacist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
VAD000 | Medicare UPIN |