Provider Demographics
NPI:1518330042
Name:TANG, SONTUNG THAO (PHARMD)
Entity Type:Individual
Prefix:
First Name:SONTUNG
Middle Name:THAO
Last Name:TANG
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 1:21650 US HIGHWAY 18
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-3990
Mailing Address - Country:US
Mailing Address - Phone:760-240-0866
Mailing Address - Fax:
Practice Address - Street 1:21650 US HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-3990
Practice Address - Country:US
Practice Address - Phone:760-240-0866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73928183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH 73928OtherCALIFORNIA BOARD OF PHARMACY