MEDICARE: LAI MAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	44570	TX

General Provider Information

NPI Number	:	1053625905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAI MAN

Provider Business Mailing Address
First Line	:	3663 BRIARPARK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-5205
Country	:	US
Telephone Number	:	713-268-3630
Fax Number	:	623-869-1717

Provider Business Practice Location Address
First Line	:	3000 S HULEN ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-1929
Country	:	US
Telephone Number	:	817-570-2960
Fax Number	:	817-570-2965

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2010
Last Update Date	:	08/03/2010

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Directions to “ LAI MAN ” Practice Location

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