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NPI Code Detail

MEDICARE: XIANGYU TAN

MEDICARE: XIANGYU TAN
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
1183500000XPharmacist16236OK

General Provider Information

NPI Number : 1790151504
Entity Type Code : Individual
Provider Name (Legal Business Name) : XIANGYU TAN
Provider Business Mailing Address
First Line : 6350 N MACARTHUR BLVD
Second Line :
City : WARR ACRES
State : OK
Zip : 73122-7213
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6350 N MACARTHUR BLVD
Second Line :
City : WARR ACRES
State : OK
Zip : 73122-7213
Country : US
Telephone Number : 405-728-8396
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2015
Last Update Date : 08/16/2015

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Directions to “ XIANGYU TAN ” Practice Location

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