MEDICARE: DR. KWOK KWONG WONG PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH-0012298	OR

General Provider Information

NPI Number	:	1013236199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KWOK KWONG WONG PHARMD

Provider Business Mailing Address
First Line	:	817 NW EDGEWOOD PL
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97321-1310
Country	:	US
Telephone Number	:	541-926-2600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1235 WAVERLY DR SE
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97322-6944
Country	:	US
Telephone Number	:	541-926-8668
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2010
Last Update Date	:	08/12/2010

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