Provider Demographics
NPI:1992986335
Name:LAI, CO QUOC (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CO
Middle Name:QUOC
Last Name:LAI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 EVERGLADE LN
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-7399
Mailing Address - Country:US
Mailing Address - Phone:520-295-3472
Mailing Address - Fax:
Practice Address - Street 1:3409 EVERGLADE LN
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-7399
Practice Address - Country:US
Practice Address - Phone:520-295-3472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist