Provider Demographics
NPI:1023612769
Name:HOANG, LAM BA
Entity type:Individual
Prefix:
First Name:LAM
Middle Name:BA
Last Name:HOANG
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 1:290 W LAKE PARK RD APT 915
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3888
Mailing Address - Country:US
Mailing Address - Phone:916-690-7664
Mailing Address - Fax:
Practice Address - Street 1:805 W CARRIER PKWY STE 240
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-1089
Practice Address - Country:US
Practice Address - Phone:424-347-6299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67332183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist