MEDICARE: TANG PHARMACY V 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	PP482363	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2140032	OTHER		PK

General Provider Information

NPI Number	:	1164866208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TANG PHARMACY V INC

Provider Business Mailing Address
First Line	:	7452 OGONTZ AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19138-1324
Country	:	US
Telephone Number	:	215-548-1800
Fax Number	:	215-548-1801

Provider Business Practice Location Address
First Line	:	7452 OGONTZ AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19138-1324
Country	:	US
Telephone Number	:	215-548-1800
Fax Number	:	215-548-1801

Authorized Official
Title or Position	:	OWNER
Name	:	DANIEL TANG
Credential	:
Telephone Number	:	215-704-1222

Provider Enumeration Date	:	04/19/2013
Last Update Date	:	05/10/2013

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