Provider Demographics
NPI:1386929818
Name:WANG, TOMMYPENG (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TOMMYPENG
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418-7827
Mailing Address - Country:US
Mailing Address - Phone:253-473-5215
Mailing Address - Fax:253-473-9022
Practice Address - Street 1:3737 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418-7827
Practice Address - Country:US
Practice Address - Phone:253-473-5215
Practice Address - Fax:253-473-9022
Is Sole Proprietor?:No
Enumeration Date:2011-10-16
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17917183500000X
WAPH 60274917183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist