Provider Demographics
NPI:1003448747
Name:TANG, MI TIEU (RPH)
Entity Type:Individual
Prefix:MS
First Name:MI
Middle Name:TIEU
Last Name:TANG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5603 BYRON CENTER AVE SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-8606
Mailing Address - Country:US
Mailing Address - Phone:616-530-2338
Mailing Address - Fax:616-530-2592
Practice Address - Street 1:5603 BYRON CENTER AVE SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-8606
Practice Address - Country:US
Practice Address - Phone:616-530-2338
Practice Address - Fax:616-530-2592
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031938183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist