Provider Demographics
NPI:1881642742
Name:TAM, JENNIFER WAI-YAN (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WAI-YAN
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 1:2111 SAN PABLO AVE UNIT 2265
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-5015
Mailing Address - Country:US
Mailing Address - Phone:510-570-8585
Mailing Address - Fax:
Practice Address - Street 1:1600 DIVISADERO ST RM A002
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-3010
Practice Address - Country:US
Practice Address - Phone:415-353-7052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH551341835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist