MEDICARE: TINA WANG PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	055310	NY

General Provider Information

NPI Number	:	1033495742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA WANG PHARMD

Provider Business Mailing Address
First Line	:	4915 FLATLANDS AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-2115
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4915 FLATLANDS AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-2115
Country	:	US
Telephone Number	:	347-856-5852
Fax Number	:	718-258-8390

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2011
Last Update Date	:	05/12/2017

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Directions to “ TINA WANG PHARMD” Practice Location

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