Provider Demographics
NPI:1750408837
Name:NAM PHARMACY
Entity type:Organization
Organization Name:NAM PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HIEN
Authorized Official - Middle Name:QUY
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:408-295-6111
Mailing Address - Street 1:804 EAST JULIAN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-1809
Mailing Address - Country:US
Mailing Address - Phone:408-295-6111
Mailing Address - Fax:408-295-6012
Practice Address - Street 1:804 EAST JULIAN ST
Practice Address - Street 2:SUITE C
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-1809
Practice Address - Country:US
Practice Address - Phone:408-295-6111
Practice Address - Fax:408-295-6012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA394400Medicaid
CA5530450001Medicare NSC