MEDICARE: TANG PHARMACY INC

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	3336C0003X	Community/Retail Pharmacy	PP481608	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2087834	OTHER		PK

General Provider Information

NPI Number	:	1093829988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TANG PHARMACY INC

Provider Business Mailing Address
First Line	:	5925 N 5TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-1823
Country	:	US
Telephone Number	:	215-224-1500
Fax Number	:	215-224-6500

Provider Business Practice Location Address
First Line	:	5925 N 5TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-1823
Country	:	US
Telephone Number	:	215-224-1500
Fax Number	:	215-224-6500

Authorized Official
Title or Position	:	PHARMACY MGR
Name	:	DANIEL TANG
Credential	:
Telephone Number	:	215-224-1500

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	03/07/2016

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