Provider Demographics
NPI:1790061547
Name:TANG PHARMACY IV INC
Entity Type:Organization
Organization Name:TANG PHARMACY IV INC
Other - Org Name:TANG PHARMACY IV
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:XUANKHOA
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:215-235-1400
Mailing Address - Street 1:900 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-1604
Mailing Address - Country:US
Mailing Address - Phone:215-235-1400
Mailing Address - Fax:215-235-1445
Practice Address - Street 1:900 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-1604
Practice Address - Country:US
Practice Address - Phone:215-235-1400
Practice Address - Fax:215-235-1445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4821793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102652502001Medicaid
2132479OtherPK