Provider Demographics
NPI:1073895108
Name:WANG, TAK TZAI (PHARMD)
Entity Type:Individual
Prefix:
First Name:TAK
Middle Name:TZAI
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 1:2680 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-1348
Mailing Address - Country:US
Mailing Address - Phone:408-371-5426
Mailing Address - Fax:408-371-5507
Practice Address - Street 1:2680 UNION AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-1348
Practice Address - Country:US
Practice Address - Phone:408-371-5426
Practice Address - Fax:408-371-5507
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC31421183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist