MEDICARE: MR. RAYMOND BOB WONG RPH,I

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	029376	NY

General Provider Information

NPI Number	:	1558545657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAYMOND BOB WONG RPH,I

Provider Business Mailing Address
First Line	:	214 VALLEY RD
Second Line	:
City	:	VALLEY COTTAGE
State	:	NY
Zip	:	10989-2439
Country	:	US
Telephone Number	:	845-267-8386
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 N MAIN ST
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-3719
Country	:	US
Telephone Number	:	845-638-1537
Fax Number	:

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

Provider Enumeration Date	:	12/26/2007
Last Update Date	:	05/01/2009

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