Healthcare Provider Details

I. General information

NPI: 1164620183
Provider Name (Legal Business Name): TEP M KANG PHARMD, BCPS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CLEMSON DR
GARNET VALLEY PA
19061-1621
US

IV. Provider business mailing address

4755 OGLETOWN-STANTON ROAD
NEWARK DE
19718-0001
US

V. Phone/Fax

Practice location:
  • Phone: 610-358-2235
  • Fax:
Mailing address:
  • Phone: 302-733-6333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License NumberA1-002858
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: