Provider Demographics
NPI:1154918464
Name:NAM, CHAN SOK (PHARMD)
Entity type:Individual
Prefix:
First Name:CHAN SOK
Middle Name:
Last Name:NAM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319A 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-2279
Mailing Address - Country:US
Mailing Address - Phone:201-835-6464
Mailing Address - Fax:
Practice Address - Street 1:160 KINGSLAND RD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07014-1915
Practice Address - Country:US
Practice Address - Phone:973-779-6697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03460500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist