Basic Information
| Provider Information | |||||||||
| NPI: | 1760769228 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WANG | ||||||||
| FirstName: | TINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8343 N WILLOW VIEW DR | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857413938 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2175 W RUTHRAUFF RD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857051241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202922549 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2011 | ||||||||
| LastUpdateDate: | 10/15/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | S019165 | AZ | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.