MEDICARE: KRYSTIN FONG WANG 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	62537	CA

General Provider Information

NPI Number	:	1184855090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTIN FONG WANG PHARMD

Provider Business Mailing Address
First Line	:	2345 FAIR OAKS BLVD
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-4708
Country	:	US
Telephone Number	:	916-207-9869
Fax Number	:

Provider Business Practice Location Address
First Line	:	7933 COLLINS ISLE LN
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95831-5843
Country	:	US
Telephone Number	:	916-207-9869
Fax Number	:

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

Provider Enumeration Date	:	07/27/2009
Last Update Date	:	12/17/2021

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