Provider Demographics
NPI:1114072881
Name:TANG, LY PHA B (RPH)
Entity Type:Individual
Prefix:MISS
First Name:LY PHA
Middle Name:B
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 1:2181 BOGART AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-2107
Mailing Address - Country:US
Mailing Address - Phone:718-823-9701
Mailing Address - Fax:
Practice Address - Street 1:LINCOLN HOSPITAL
Practice Address - Street 2:234 EAST 149 ST - C 23 PHARMACY
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451
Practice Address - Country:US
Practice Address - Phone:718-579-5523
Practice Address - Fax:718-579-5003
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046090-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist