Provider Demographics
NPI:1649581489
Name:LAM, CUONG TRI (PHARMD)
Entity Type:Individual
Prefix:
First Name:CUONG
Middle Name:TRI
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 1:601 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-1331
Mailing Address - Country:US
Mailing Address - Phone:562-435-2083
Mailing Address - Fax:
Practice Address - Street 1:601 PINE AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-1331
Practice Address - Country:US
Practice Address - Phone:562-435-2083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-26
Last Update Date:2010-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58079183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist