Healthcare Provider Details

I. General information

NPI: 1811625247
Provider Name (Legal Business Name): CHRISTINA TANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 REMBERT C DENNIS BLVD
MONCKS CORNER SC
29461-3941
US

IV. Provider business mailing address

217 SAINT AWDRY ST
SUMMERVILLE SC
29485-4069
US

V. Phone/Fax

Practice location:
  • Phone: 843-761-8261
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43590
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: