Provider Demographics
NPI:1518551530
Name:TANGER, KIMBERLY ANNE (LICENSED CPHT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNE
Last Name:TANGER
Suffix:
Gender:F
Credentials:LICENSED CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 PLEASANT ST APT 1
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-0032
Mailing Address - Country:US
Mailing Address - Phone:617-307-8900
Mailing Address - Fax:781-485-0780
Practice Address - Street 1:430 BROADWAY
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3058
Practice Address - Country:US
Practice Address - Phone:781-289-3607
Practice Address - Fax:781-485-0780
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPT4918183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician