Healthcare Provider Details

I. General information

NPI: 1336052455
Provider Name (Legal Business Name): LILLI-ANNE R WONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24745 STEWART ST
LOMA LINDA CA
92350-1719
US

IV. Provider business mailing address

6339 CEDAR CREEK RD
EASTVALE CA
92880-8655
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-1300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberINT51659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: