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NPI Code Detail

MEDICARE: AMANDA SOPHIE LAM

MEDICARE: AMANDA SOPHIE LAM
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
1183500000XPharmacist75315CA

General Provider Information

NPI Number : 1013467836
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA SOPHIE LAM
Provider Business Mailing Address
First Line : 29465 MAJOR LEAGUE
Second Line :
City : LAKE ELSINORE
State : CA
Zip : 92530-4338
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 160 DIAMOND DR
Second Line :
City : LAKE ELSINORE
State : CA
Zip : 92530-4401
Country : US
Telephone Number : 951-674-3562
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2016
Last Update Date : 10/04/2016

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Directions to “ AMANDA SOPHIE LAM ” Practice Location

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