Provider Demographics
NPI:1013513266
Name:LAM, CHAU VU THAI (RPH)
Entity type:Individual
Prefix:
First Name:CHAU
Middle Name:VU THAI
Last Name:LAM
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 1:10109 CRANBERRY ISLE DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93314-8093
Mailing Address - Country:US
Mailing Address - Phone:714-548-0333
Mailing Address - Fax:
Practice Address - Street 1:715 AIRPORT DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-4129
Practice Address - Country:US
Practice Address - Phone:661-392-7059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83952183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist