Provider Demographics
NPI:1417671801
Name:TSANG, JACKY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JACKY
Middle Name:
Last Name:TSANG
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 1:100 HEATHROW AVE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-6466
Mailing Address - Country:US
Mailing Address - Phone:603-325-0456
Mailing Address - Fax:
Practice Address - Street 1:11 STEEPLE WAY
Practice Address - Street 2:
Practice Address - City:WELLS
Practice Address - State:ME
Practice Address - Zip Code:04090-5399
Practice Address - Country:US
Practice Address - Phone:207-641-0860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHPR71197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist