MEDICARE: ALEXANDER WANG

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	PH200004456	DC

General Provider Information

NPI Number	:	1588437420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER WANG

Provider Business Mailing Address
First Line	:	127 S SAN VINCENTE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	127 S SAN VINCENTE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048
Country	:	US
Telephone Number	:	310-426-4771
Fax Number	:

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

Provider Enumeration Date	:	11/02/2023
Last Update Date	:	01/27/2026

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Directions to “ ALEXANDER WANG ” Practice Location

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