Provider Demographics
NPI:1245554740
Name:HO, CLEMENT HOI LAM (RPH)
Entity type:Individual
Prefix:MR
First Name:CLEMENT HOI LAM
Middle Name:
Last Name:HO
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 1:4213 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3855
Mailing Address - Country:US
Mailing Address - Phone:917-815-2223
Mailing Address - Fax:718-539-3948
Practice Address - Street 1:4213 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3855
Practice Address - Country:US
Practice Address - Phone:917-815-2223
Practice Address - Fax:718-539-3948
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045166183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02055530Medicaid