Provider Demographics
NPI:1962806562
Name:LAM, SANDY
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:LAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4548 CENTERPLACE DR
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-3747
Mailing Address - Country:US
Mailing Address - Phone:970-330-9962
Mailing Address - Fax:970-330-9967
Practice Address - Street 1:4548 CENTERPLACE DR
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3747
Practice Address - Country:US
Practice Address - Phone:970-330-9962
Practice Address - Fax:970-330-9967
Is Sole Proprietor?:No
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO16410OtherSTATE LICENSE