Provider Demographics
NPI:1023684305
Name:LAM, NAOMI
Entity type:Individual
Prefix:
First Name:NAOMI
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 1:15249 SE PIONEER DR
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-7316
Mailing Address - Country:US
Mailing Address - Phone:503-481-0841
Mailing Address - Fax:
Practice Address - Street 1:15249 SE PIONEER DR
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-7316
Practice Address - Country:US
Practice Address - Phone:503-481-0841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0013330183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORCON-0000029OtherCONSULTING/DRUGLESS PHARMACY REGISTRATION NUMBER