Healthcare Provider Details

I. General information

NPI: 1790600260
Provider Name (Legal Business Name): BONNIE TAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N MIDLAND AVE
NYACK NY
10960-1912
US

IV. Provider business mailing address

412 59TH ST
BROOKLYN NY
11220-3814
US

V. Phone/Fax

Practice location:
  • Phone: 845-348-2000
  • Fax:
Mailing address:
  • Phone: 646-696-8609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number073357
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: