Provider Demographics
NPI:1538625579
Name:TANG, KYLE KHAI (PHARM D)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:KHAI
Last Name:TANG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10303 THIRTY KNOTS LN
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-3402
Mailing Address - Country:US
Mailing Address - Phone:215-868-8129
Mailing Address - Fax:
Practice Address - Street 1:125 E NORTH POINTE DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-2283
Practice Address - Country:US
Practice Address - Phone:410-572-8518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD255211835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist