MEDICARE: DR. CANDY SIU-WAI TANG 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	18394	MD

General Provider Information

NPI Number	:	1659665917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CANDY SIU-WAI TANG PHARMD

Provider Business Mailing Address
First Line	:	6717 GOVERNOR RITCHIE HWY
Second Line	:	T-1938
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-2318
Country	:	US
Telephone Number	:	410-487-0039
Fax Number	:	410-487-0039

Provider Business Practice Location Address
First Line	:	6717 GOVERNOR RITCHIE HWY
Second Line	:	T-1938
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-2318
Country	:	US
Telephone Number	:	410-487-0039
Fax Number	:	410-487-0039

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

Provider Enumeration Date	:	06/04/2011
Last Update Date	:	06/04/2011

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