Healthcare Provider Details

I. General information

NPI: 1093208522
Provider Name (Legal Business Name): PETER TANG PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2018
Last Update Date: 11/06/2021
Certification Date: 11/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 KENSICO RD
THORNWOOD NY
10594-1143
US

IV. Provider business mailing address

111 E 210TH ST
BRONX NY
10467-2401
US

V. Phone/Fax

Practice location:
  • Phone: 914-747-0239
  • Fax:
Mailing address:
  • Phone: 718-920-4103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number063677
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: