Provider Demographics
NPI:1992336838
Name:TANG, PHUONG MINH (PHARMACIST)
Entity type:Individual
Prefix:
First Name:PHUONG
Middle Name:MINH
Last Name:TANG
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:TANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3600 GUS THOMASSON RD
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6200
Mailing Address - Country:US
Mailing Address - Phone:972-270-2401
Mailing Address - Fax:
Practice Address - Street 1:3600 GUS THOMASSON RD
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6200
Practice Address - Country:US
Practice Address - Phone:972-270-2401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist