Healthcare Provider Details

I. General information

NPI: 1679896369
Provider Name (Legal Business Name): TANG TRAN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2010
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3575 BOSTON RD
BRONX NY
10469-2518
US

IV. Provider business mailing address

3575 BOSTON RD
BRONX NY
10469-2518
US

V. Phone/Fax

Practice location:
  • Phone: 347-601-4018
  • Fax: 347-601-4021
Mailing address:
  • Phone: 347-601-4018
  • Fax: 347-601-4021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number047713
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: