MEDICARE: DOUG 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
1	183500000X	Pharmacist	RPH56706	CA

General Provider Information

NPI Number	:	1306131271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUG LAM

Provider Business Mailing Address
First Line	:	7505 LAGUNA BLVD
Second Line	:	T1025
City	:	ELK GROVE
State	:	CA
Zip	:	95758-5061
Country	:	US
Telephone Number	:	916-683-2936
Fax Number	:	916-683-2936

Provider Business Practice Location Address
First Line	:	7505 LAGUNA BLVD
Second Line	:	T1025
City	:	ELK GROVE
State	:	CA
Zip	:	95758-5061
Country	:	US
Telephone Number	:	916-683-2936
Fax Number	:	916-683-2936

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

Provider Enumeration Date	:	06/18/2011
Last Update Date	:	06/18/2011

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Directions to “ DOUG LAM ” Practice Location

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