Provider Demographics
NPI:1902146814
Name:TAN, KOK HONG (RPH)
Entity Type:Individual
Prefix:MR
First Name:KOK HONG
Middle Name:
Last Name:TAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4616 PINE BROOK DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3960
Mailing Address - Country:US
Mailing Address - Phone:214-298-5928
Mailing Address - Fax:
Practice Address - Street 1:4616 PINE BROOK DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3960
Practice Address - Country:US
Practice Address - Phone:214-298-5928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42298183500000X
AZS012043183500000X
CO15286183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO15286OtherSTATE BOARD OF PHARMACY
TX42298OtherSTATE BOARD OF PHARMACY
AZS012043OtherSTATE BOARD OF PHARMACY