MEDICARE: MR. HENRY TANG R.PH., AE-C

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	8514	OR
2	183500000X	Pharmacist	17707	MA
3	183500000X	Pharmacist	60028510	WA
4	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	8514	OR

General Provider Information

NPI Number	:	1710972500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HENRY TANG R.PH., AE-C

Provider Business Mailing Address
First Line	:	4560 SE INTERNATIONAL WAY STE 101
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-4628
Country	:	US
Telephone Number	:	971-206-5100
Fax Number	:	503-652-0383

Provider Business Practice Location Address
First Line	:	4560 SE INTERNATIONAL WAY STE 101
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-4628
Country	:	US
Telephone Number	:	971-206-5100
Fax Number	:	503-652-0383

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

Provider Enumeration Date	:	09/17/2005
Last Update Date	:	03/13/2016

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