Healthcare Provider Details

I. General information

NPI: 1306127196
Provider Name (Legal Business Name): TAMARA MALM PHARMD, MPH, BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 CHAPEL ST
NEW HAVEN CT
06511
US

IV. Provider business mailing address

23 HAYWARD RD
HAMDEN CT
06514-3326
US

V. Phone/Fax

Practice location:
  • Phone: 203-789-4044
  • Fax:
Mailing address:
  • Phone: 859-396-7545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberI09090
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number0013001
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: