Provider Demographics
NPI:1063041903
Name:TO, TAM MINH (PHARMD)
Entity Type:Individual
Prefix:
First Name:TAM
Middle Name:MINH
Last Name:TO
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 1:307 CHECKERS DR APT 203
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133-2254
Mailing Address - Country:US
Mailing Address - Phone:408-679-3661
Mailing Address - Fax:
Practice Address - Street 1:307 CHECKERS DR APT 203
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95133-2254
Practice Address - Country:US
Practice Address - Phone:408-679-3661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82193183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist