Provider Demographics
NPI:1902412489
Name:LAM, ANDY (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:
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 1:181 SILVER ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-5506
Mailing Address - Country:US
Mailing Address - Phone:781-417-0889
Mailing Address - Fax:
Practice Address - Street 1:271 MAMMOTH RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03109-4124
Practice Address - Country:US
Practice Address - Phone:603-623-3995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-19
Last Update Date:2020-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH01048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist