Provider Demographics
NPI:1245503226
Name:PANG, TUREN
Entity type:Individual
Prefix:
First Name:TUREN
Middle Name:
Last Name:PANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16735 SE 272ND ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-4942
Mailing Address - Country:US
Mailing Address - Phone:253-639-7433
Mailing Address - Fax:253-639-7427
Practice Address - Street 1:16735 SE 272ND ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-4942
Practice Address - Country:US
Practice Address - Phone:253-639-7433
Practice Address - Fax:253-639-7427
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00042134183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist