Provider Demographics
NPI:1275824542
Name:TAM, COURTNEY L (PHARMD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:L
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 1:30 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6629
Mailing Address - Country:US
Mailing Address - Phone:646-665-6000
Mailing Address - Fax:
Practice Address - Street 1:30 7TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6629
Practice Address - Country:US
Practice Address - Phone:646-665-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2020-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03399400183500000X
CTPCT.0011848183500000X
NYI055461183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist