Healthcare Provider Details

I. General information

NPI: 1265419816
Provider Name (Legal Business Name): YUEN SIM LAI PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 1ST ST
PRAIRIE DU SAC WI
53578-1550
US

IV. Provider business mailing address

1260 DEMING WAY APT 308
MADISON WI
53717-1992
US

V. Phone/Fax

Practice location:
  • Phone: 608-643-7243
  • Fax:
Mailing address:
  • Phone: 414-241-5443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number118420-0
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13846-040
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: