Healthcare Provider Details

I. General information

NPI: 1891463725
Provider Name (Legal Business Name): HONG DAO TANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 W LEHIGH AVE
PHILADELPHIA PA
19133-3425
US

IV. Provider business mailing address

4307 K ST
PHILADELPHIA PA
19124-4321
US

V. Phone/Fax

Practice location:
  • Phone: 215-425-3784
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP456073
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: