Provider Demographics
NPI:1952656647
Name:TANG, SIMON T (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:SIMON
Middle Name:T
Last Name:TANG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:MR
Other - First Name:SIMON
Other - Middle Name:T
Other - Last Name:TANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:19710 131ST PL NE
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-5766
Mailing Address - Country:US
Mailing Address - Phone:425-483-1449
Mailing Address - Fax:
Practice Address - Street 1:19710 131ST PL NE
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072
Practice Address - Country:US
Practice Address - Phone:425-483-1449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00040150183500000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH 0040150OtherWA STATE DEPARTMENT OF HEALTH