Healthcare Provider Details

I. General information

NPI: 1770795213
Provider Name (Legal Business Name): WUFENG C TANG PHARM,D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7020 WEST STATE ST.
BOISE ID
83703
US

IV. Provider business mailing address

13193 WEST MEADOWDALE DR.
BOISE ID
83713
US

V. Phone/Fax

Practice location:
  • Phone: 208-853-3503
  • Fax: 208-853-4328
Mailing address:
  • Phone: 208-639-2031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP5861
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: