Provider Demographics
NPI:1295035632
Name:TAM, ANITA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
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 1:2020 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1314
Mailing Address - Country:US
Mailing Address - Phone:415-436-9032
Mailing Address - Fax:415-861-0196
Practice Address - Street 1:2020 MARKET ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1314
Practice Address - Country:US
Practice Address - Phone:415-436-9032
Practice Address - Fax:415-861-0196
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist