Provider Demographics
NPI:1700197845
Name:TAN, AUNG AUNG (RPH)
Entity Type:Individual
Prefix:
First Name:AUNG
Middle Name:AUNG
Last Name:TAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3019
Mailing Address - Country:US
Mailing Address - Phone:646-359-2533
Mailing Address - Fax:
Practice Address - Street 1:193 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3019
Practice Address - Country:US
Practice Address - Phone:646-359-2533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ02452000183500000X
PA444486183500000X
NY048326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist