Provider Demographics
NPI:1710222179
Name:TANG, XINNAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:XINNAN
Middle Name:
Last Name:TANG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 S M ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-3654
Mailing Address - Country:US
Mailing Address - Phone:253-572-7753
Mailing Address - Fax:
Practice Address - Street 1:1112 S M ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-3654
Practice Address - Country:US
Practice Address - Phone:253-572-7753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-11
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3077183500000X
FL47022183500000X
WA60306294183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist