Provider Demographics
NPI:1790177988
Name:TANG, ALBERT (BSP)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:TANG
Suffix:
Gender:M
Credentials:BSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 S GRADY WAY
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-3226
Mailing Address - Country:US
Mailing Address - Phone:425-793-7937
Mailing Address - Fax:425-793-7939
Practice Address - Street 1:901 S GRADY WAY
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-3226
Practice Address - Country:US
Practice Address - Phone:425-793-7937
Practice Address - Fax:425-793-7939
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH19556183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist