Provider Demographics
NPI:1770022782
Name:LAM, WAYNE
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:LAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 E PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-2013
Mailing Address - Country:US
Mailing Address - Phone:562-986-2260
Mailing Address - Fax:562-986-2288
Practice Address - Street 1:3900 E PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2013
Practice Address - Country:US
Practice Address - Phone:562-986-2260
Practice Address - Fax:562-986-2288
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56023183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist