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General NPI Number Information
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NPI Number | 1083226732
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Entity Type | Individual
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Provider Name | ALEX LAM
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Gender | Male
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Dates
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Enumeration Date | 08/22/2020
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2025 1ST AVE SE
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City | MOULTRIE
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State | GA
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Zip | 31788-5155
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Country | US
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Telephone | 229-890-2776
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Fax |
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Provider Business Mailing Address
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Address Line | 100 GARDEN DR APT B33
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City | VALDOSTA
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State | GA
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Zip | 31602-5958
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Country | US
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Telephone | 408-838-3389
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | RPH030593
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License Number State | GA
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