Provider Demographics
NPI:1285343772
Name:TANG, TRACY MY TUYEN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:MY TUYEN
Last Name:TANG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17631 21ST AVE W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-5328
Mailing Address - Country:US
Mailing Address - Phone:971-678-2356
Mailing Address - Fax:
Practice Address - Street 1:300 BELLEVUE WAY NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5718
Practice Address - Country:US
Practice Address - Phone:425-749-3889
Practice Address - Fax:425-749-3890
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61324207183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist