Provider Demographics
NPI:1174959555
Name:TANG, FLETCHER K (PHARMD)
Entity type:Individual
Prefix:
First Name:FLETCHER
Middle Name:K
Last Name:TANG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 NE DIVISION STREET
Mailing Address - Street 2:APARTMENT 311
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3111
Mailing Address - Country:US
Mailing Address - Phone:503-666-9476
Mailing Address - Fax:
Practice Address - Street 1:1555 NE DIVISION ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-4271
Practice Address - Country:US
Practice Address - Phone:503-666-9476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0013731183500000X
ORORRPH00137311835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist