MEDICARE: DR. SIVAN LAM PHARM.D.

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	PS 40530	FL
2	183500000X	Pharmacist	26225	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PS 40530	OTHER	FL	STATE PHARM.D LICENSE

General Provider Information

NPI Number	:	1710017470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIVAN LAM PHARM.D.

Provider Business Mailing Address
First Line	:	2849 NW 4TH ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33993-7038
Country	:	US
Telephone Number	:	239-283-2574
Fax Number	:

Provider Business Practice Location Address
First Line	:	2849 NW 4TH ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33993-7038
Country	:	US
Telephone Number	:	239-283-2574
Fax Number	:

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/08/2007

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