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General NPI Number Information
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NPI Number | 1790061547
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Entity Type | Organization
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Legal Business Name | TANG PHARMACY IV INC
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Dates
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Enumeration Date | 10/25/2011
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Last Update Date | 02/14/2022
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Provider Practice Location Address
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Address Line | 900 N BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19130-1604
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Country | US
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Telephone | 215-235-1400
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Fax | 215-235-1445
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Provider Business Mailing Address
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Address Line | 900 N BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19130-1604
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Country | US
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Telephone | 215-235-1400
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Fax | 215-235-1445
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Authorized Official
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Title or Position | PHARMACIST
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Name | XUANKHOA NGUYEN
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Credential | RPH
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Telephone | 215-235-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP482179
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License Number State | PA
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