Provider Demographics
NPI:1124634019
Name:LAM, TOAN (PHARMACIST)
Entity type:Individual
Prefix:
First Name:TOAN
Middle Name:
Last Name:LAM
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 BOLES FARM LN
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5440
Mailing Address - Country:US
Mailing Address - Phone:770-633-6208
Mailing Address - Fax:
Practice Address - Street 1:6410 W JOHNS XING
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1507
Practice Address - Country:US
Practice Address - Phone:770-476-9401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH026996333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy