Provider Demographics
NPI:1073236147
Name:TANJONG, IRINE SHIRE
Entity Type:Individual
Prefix:DR
First Name:IRINE
Middle Name:SHIRE
Last Name:TANJONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 E EXPRESSWAY 83
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1609
Mailing Address - Country:US
Mailing Address - Phone:956-686-4068
Mailing Address - Fax:
Practice Address - Street 1:708 E EXPRESSWAY 83
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1609
Practice Address - Country:US
Practice Address - Phone:956-686-4068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59267183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist