Individual
TRAVIS TUAN TANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2125 NW STEWART PKWY, ROSEBURG, OR 97471-1693
(541) 957-8544
Mailing address
1064 NE LINCOLN ST, ROSEBURG, OR 97470-2121
(541) 580-8907
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
RPH-0017619
OR
Other
Enumeration date
01/14/2020
Last updated
01/14/2020
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