Individual
LYDIA LAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3002 MOUNT EPHRAIM AVENUE, HADDON TOWNSHIP, NJ 08104
(856) 854-9259
Mailing address
6011 EDMUND ST, PHILADELPHIA, PA 19135-3705
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30761822
DRIVER'S LICENSE
PA
Enumeration date
12/03/2020
Last updated
12/03/2020
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