Provider Demographics
NPI:1992309330
Name:AN, BO LAM (PHARM D)
Entity type:Individual
Prefix:DR
First Name:BO
Middle Name:LAM
Last Name:AN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11458 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-4200
Mailing Address - Country:US
Mailing Address - Phone:540-775-2284
Mailing Address - Fax:
Practice Address - Street 1:11458 KINGS HWY
Practice Address - Street 2:
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-4200
Practice Address - Country:US
Practice Address - Phone:540-775-2284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27094183500000X
VA0202218381183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist