Provider Demographics
NPI:1912747841
Name:FANG, SI (PHARMD, MBA)
Entity type:Individual
Prefix:
First Name:SI
Middle Name:
Last Name:FANG
Suffix:
Gender:M
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:STEVEN
Other - Middle Name:
Other - Last Name:FANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD, MBA
Mailing Address - Street 1:1590 W FRONTIER PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-3196
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1590 W FRONTIER PKWY STE 100
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-3196
Practice Address - Country:US
Practice Address - Phone:469-296-1679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX590871835P0018X, 1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist