Provider Demographics
NPI:1184253072
Name:PATRICK, LAEL WAN (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:LAEL
Middle Name:WAN
Last Name:PATRICK
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10956 DONNER PASS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-4860
Mailing Address - Country:US
Mailing Address - Phone:530-587-7607
Mailing Address - Fax:530-587-6771
Practice Address - Street 1:10956 DONNER PASS RD STE 100
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4860
Practice Address - Country:US
Practice Address - Phone:530-587-7607
Practice Address - Fax:530-587-6771
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60647183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist