MEDICARE: HIEN NGOC LAI PHARM.D.

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	1835P1200X	Pharmacotherapy Pharmacist	25055	MA

General Provider Information

NPI Number	:	1497926760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HIEN NGOC LAI PHARM.D.

Provider Business Mailing Address
First Line	:	10200 N ARMENIA AVENUE
Second Line	:	APT # 2002
City	:	TAMPA
State	:	FL
Zip	:	33612
Country	:	US
Telephone Number	:	617-913-2592
Fax Number	:

Provider Business Practice Location Address
First Line	:	10200 N ARMENIA AVE
Second Line	:	APT # 2002
City	:	TAMPA
State	:	FL
Zip	:	33612-7364
Country	:	US
Telephone Number	:	617-913-2592
Fax Number	:

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

Provider Enumeration Date	:	03/14/2008
Last Update Date	:	03/14/2008

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