MEDICARE: AILEEN NGOC 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	74258	CA

General Provider Information

NPI Number	:	1528508306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AILEEN NGOC LAM

Provider Business Mailing Address
First Line	:	40420 MURRIETA HOT SPRINGS RD
Second Line	:
City	:	MURRIETA
State	:	CA
Zip	:	92563-6400
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	40420 MURRIETA HOT SPRINGS RD
Second Line	:
City	:	MURRIETA
State	:	CA
Zip	:	92563-6400
Country	:	US
Telephone Number	:	951-698-7459
Fax Number	:

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

Provider Enumeration Date	:	02/28/2017
Last Update Date	:	02/28/2017

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