Provider Demographics
NPI:1922359645
Name:LAM, LINDA S (R PH)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:S
Last Name:LAM
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 N KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-3638
Mailing Address - Country:US
Mailing Address - Phone:843-626-2295
Mailing Address - Fax:843-445-6536
Practice Address - Street 1:1403 N KINGS HWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-3638
Practice Address - Country:US
Practice Address - Phone:843-626-2295
Practice Address - Fax:843-445-6536
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8115183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist