Provider Demographics
NPI:1255645842
Name:NAM, PATRICK S (RPH)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:S
Last Name:NAM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 KRISTEN LN
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:NJ
Mailing Address - Zip Code:08051-1660
Mailing Address - Country:US
Mailing Address - Phone:609-413-2688
Mailing Address - Fax:
Practice Address - Street 1:380 HARMONY RD
Practice Address - Street 2:
Practice Address - City:GIBBSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08027-1702
Practice Address - Country:US
Practice Address - Phone:856-423-3831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02604100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist