Healthcare Provider Details

I. General information

NPI: 1114072881
Provider Name (Legal Business Name): LY PHA B TANG RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LINCOLN HOSPITAL 234 EAST 149 ST - C 23 PHARMACY
BRONX NY
10451
US

IV. Provider business mailing address

2181 BOGART AVE
BRONX NY
10462-2107
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-5523
  • Fax: 718-579-5003
Mailing address:
  • Phone: 718-823-9701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number046090-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: