Provider Demographics
NPI:1700158177
Name:DUONG, LAM Q (RPH)
Entity Type:Individual
Prefix:
First Name:LAM
Middle Name:Q
Last Name:DUONG
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 1:208 GARDINER RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-1152
Mailing Address - Country:US
Mailing Address - Phone:781-395-3233
Mailing Address - Fax:
Practice Address - Street 1:61 LOCUST ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-5713
Practice Address - Country:US
Practice Address - Phone:781-395-3233
Practice Address - Fax:781-395-3949
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21964183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0401455Medicaid
1002410001Medicare NSC