Provider Demographics
NPI:1487977542
Name:TAM, KIT LIN LYDIA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KIT LIN LYDIA
Middle Name:
Last Name:TAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 E 34TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4766
Mailing Address - Country:US
Mailing Address - Phone:212-683-3042
Mailing Address - Fax:
Practice Address - Street 1:545 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3501
Practice Address - Country:US
Practice Address - Phone:212-696-5081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55318183500000X
MN118024183500000X
NY054123183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist