Provider Demographics
NPI:1942499173
Name:LAI, PAK HIM (RPH)
Entity Type:Individual
Prefix:MR
First Name:PAK
Middle Name:HIM
Last Name:LAI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13590 SW WILLOW TOP LN
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-0942
Mailing Address - Country:US
Mailing Address - Phone:626-626-3216
Mailing Address - Fax:
Practice Address - Street 1:1025 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3827
Practice Address - Country:US
Practice Address - Phone:503-266-6381
Practice Address - Fax:503-266-6751
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9598183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist