Provider Demographics
NPI:1447926357
Name:HONG, BOI-LAM (PHARMD)
Entity type:Individual
Prefix:
First Name:BOI-LAM
Middle Name:
Last Name:HONG
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 1:4006 UNIVERSITY AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-5649
Mailing Address - Country:US
Mailing Address - Phone:319-830-0136
Mailing Address - Fax:
Practice Address - Street 1:111 W RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4233
Practice Address - Country:US
Practice Address - Phone:319-433-0490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24234183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist