Provider Demographics
NPI:1750884599
Name:AZAM, ZAIN
Entity type:Individual
Prefix:
First Name:ZAIN
Middle Name:
Last Name:AZAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 SALEM TPKE STE 104
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-6483
Mailing Address - Country:US
Mailing Address - Phone:860-608-8808
Mailing Address - Fax:860-383-2635
Practice Address - Street 1:77 SALEM TPKE STE 104
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-6483
Practice Address - Country:US
Practice Address - Phone:860-383-2630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063949183500000X
MAPH238066183500000X
CTPCT.0015149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist