Provider Demographics
NPI:1891258935
Name:TANGANG, DOMINIC NGU (PHARMD)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:NGU
Last Name:TANGANG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 N HIGHWAY 61
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-5811
Mailing Address - Country:US
Mailing Address - Phone:563-262-3755
Mailing Address - Fax:563-262-9351
Practice Address - Street 1:3003 N HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-5811
Practice Address - Country:US
Practice Address - Phone:563-262-3755
Practice Address - Fax:563-262-9351
Is Sole Proprietor?:No
Enumeration Date:2019-04-06
Last Update Date:2019-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist