Provider Demographics
NPI:1639587595
Name:LAM, LARRY TSAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:TSAN
Last Name:LAM
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 1:3901 PORTOLA PKWY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-0833
Mailing Address - Country:US
Mailing Address - Phone:657-273-5755
Mailing Address - Fax:
Practice Address - Street 1:3901 PORTOLA PKWY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92602-0833
Practice Address - Country:US
Practice Address - Phone:657-273-5755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67916183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist