Healthcare Provider Details

I. General information

NPI: 1881642742
Provider Name (Legal Business Name): JENNIFER WAI-YAN TAM PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 DIVISADERO ST RM A002
SAN FRANCISCO CA
94143-3010
US

IV. Provider business mailing address

2111 SAN PABLO AVE UNIT 2265
BERKELEY CA
94702-5015
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-7052
  • Fax:
Mailing address:
  • Phone: 510-570-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH55134
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH55134
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: