Connie Deverell Tam, PHARM.D. RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

RPH017004 Issued in GA

Practice address

Walmart Pharmacy #1658
2205 Harrison Rd
Thomson, GA 30824

Phone

(706) 595-0180

Fax

(706) 595-6037

NPI assigned

Nov 2, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy, Registered Pharmacist

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1604275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604275200000",
    "number": "1992306591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "WALMART PHARMACY #1658",
            "address_2": "2205 HARRISON RD",
            "city": "THOMSON",
            "state": "GA",
            "postal_code": "30824",
            "telephone_number": "706-595-0180",
            "fax_number": "706-595-6037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "WALMART PHARMACY #1658",
            "address_2": "2205 HARRISON RD",
            "city": "THOMSON",
            "state": "GA",
            "postal_code": "30824",
            "telephone_number": "706-595-0180",
            "fax_number": "706-595-6037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAM",
        "first_name": "CONNIE",
        "middle_name": "DEVERELL",
        "credential": "PHARM.D. RPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-02",
        "last_updated": "2020-11-02",
        "certification_date": "2020-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "GA",
            "license": "RPH017004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in Thomson, GA
• Providers in Thomson, GA by specialty
• Pharmacist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.