Provider Demographics
NPI:1710287214
Name:NAM, SUE YEAN (PHARM D)
Entity Type:Individual
Prefix:MS
First Name:SUE
Middle Name:YEAN
Last Name:NAM
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-3120
Mailing Address - Country:US
Mailing Address - Phone:410-319-8620
Mailing Address - Fax:410-319-8618
Practice Address - Street 1:4401 HARFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-3120
Practice Address - Country:US
Practice Address - Phone:410-319-8620
Practice Address - Fax:410-319-8618
Is Sole Proprietor?:No
Enumeration Date:2010-10-30
Last Update Date:2010-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18918183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist