Provider Demographics
NPI:1548389760
Name:DAM, JAMES G (BS PHARM, MS)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:G
Last Name:DAM
Suffix:
Gender:M
Credentials:BS PHARM, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 HART ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-1144
Mailing Address - Country:US
Mailing Address - Phone:718-471-6701
Mailing Address - Fax:
Practice Address - Street 1:1728 HART ST.
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385
Practice Address - Country:US
Practice Address - Phone:718-417-6701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040022183500000X
CARPH45688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist