Provider Demographics
NPI:1841595576
Name:PHAN-TANG, AI THI (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:AI
Middle Name:THI
Last Name:PHAN-TANG
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:AI
Other - Middle Name:THI
Other - Last Name:TANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:3011 NE SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-3101
Mailing Address - Country:US
Mailing Address - Phone:425-207-0053
Mailing Address - Fax:425-207-0056
Practice Address - Street 1:3011 NE SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-3101
Practice Address - Country:US
Practice Address - Phone:425-207-0053
Practice Address - Fax:425-207-0056
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00048806183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist