Provider Demographics
NPI:1194749945
Name:LAM, RICHARD CK (RPH)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:CK
Last Name:LAM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 DANA CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2500
Mailing Address - Country:US
Mailing Address - Phone:410-461-2113
Mailing Address - Fax:410-563-1147
Practice Address - Street 1:2245 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-3113
Practice Address - Country:US
Practice Address - Phone:410-675-6046
Practice Address - Fax:410-563-1147
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD152669OtherPTAN