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General NPI Number Information
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NPI Number | 1275445249
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Entity Type | Individual
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Provider Name | ALISSA TAM PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/22/2026
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Last Update Date | 09/22/2026
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Provider Practice Location Address
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Address Line | 69 HICKORY DR STE 1
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City | WALTHAM
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State | MA
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Zip | 02451-1011
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Country | US
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Telephone | 781-373-9199
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Fax |
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Provider Business Mailing Address
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Address Line | 69 HICKORY DR STE 1
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City | WALTHAM
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State | MA
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Zip | 02451-1011
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Country | US
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Telephone | 781-373-9199
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 033.0136032
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 074456-01
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH1002407
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License Number State | MA
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