Active NPI
David Nam, PHARM.D
- Pharmacist
- Shirley, NY
National Provider Identifier
1104226844
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 057436
- Practice address
- 29 Havenwood Dr
Shirley, NY 11967-3901 - Phone
- (631) 395-4108
- NPI assigned
- Aug 31, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 057436 | NY | Primary |
| Pharmacist | 183500000X | 28RI03652700 | NJ |
Addresses
Primary practice location
29 Havenwood Dr
Shirley, NY 11967-3901
Mailing address
29 Havenwood Dr
Shirley, NY 11967-3901
Phone (631) 395-4108
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28RI03652700 | NJ | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CVS Albany LLC | Past | Accepting new patients | |
| CVS Albany LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pharmacy
- Mastic Beach (Shirley), NY
- NPI 1497910152
-
- Pharmacy
- Brooklyn, RI
- NPI 1679459481
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1409443200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1409443200000",
"number": "1104226844",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29 HAVENWOOD DR",
"city": "SHIRLEY",
"state": "NY",
"postal_code": "119673901",
"telephone_number": "631-395-4108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "29 HAVENWOOD DR",
"city": "SHIRLEY",
"state": "NY",
"postal_code": "119673901",
"telephone_number": "631-395-4108"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NAM",
"first_name": "DAVID",
"credential": "PHARM.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-08-31",
"last_updated": "2014-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "057436",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NJ",
"license": "28RI03652700",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shirley, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.