=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255612313
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LOUIS K TANG PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2011
-----------------------------------------------------
Last Update Date | 09/02/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 116 NEW MONTGOMERY ST WALGREENS # 6291
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94105-3607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-344-0891
-----------------------------------------------------
Fax | 415-344-0895
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 56 YERBA BUENA AVE
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94127-1544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-812-5979
-----------------------------------------------------
Fax | 415-344-0895
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 35905
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------