Provider Demographics
NPI:1134295918
Name:TAM, MATILDA M (PHARMD)
Entity Type:Individual
Prefix:
First Name:MATILDA
Middle Name:M
Last Name:TAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1871 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-4601
Mailing Address - Country:US
Mailing Address - Phone:415-759-7038
Mailing Address - Fax:415-759-7676
Practice Address - Street 1:275 HOSPITAL PKWY
Practice Address - Street 2:SUITE 625
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1106
Practice Address - Country:US
Practice Address - Phone:408-972-7728
Practice Address - Fax:408-363-4820
Is Sole Proprietor?:No
Enumeration Date:2006-11-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29673183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist