Provider Demographics
NPI:1639278526
Name:PANG, NELSON (PHARMD)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:PANG
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 1:1702 8TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-6104
Mailing Address - Country:US
Mailing Address - Phone:718-788-2898
Mailing Address - Fax:718-788-2703
Practice Address - Street 1:1702 8TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6104
Practice Address - Country:US
Practice Address - Phone:718-788-2898
Practice Address - Fax:718-788-2703
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist