Healthcare Provider Details

I. General information

NPI: 1568993616
Provider Name (Legal Business Name): WENDY WONG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5330 E WASHINGTON ST SUITE D-105
PHOENIX AZ
85034-2140
US

IV. Provider business mailing address

1572 N PLEASANT CT
CHANDLER AZ
85225-4375
US

V. Phone/Fax

Practice location:
  • Phone: 602-732-3384
  • Fax:
Mailing address:
  • Phone: 480-600-1286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS022321
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: