Healthcare Provider Details

I. General information

NPI: 1245011501
Provider Name (Legal Business Name): JOANNE WONG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

815 E LUCILLE AVE
WEST COVINA CA
91790-5220
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-7695
  • Fax: 714-456-5014
Mailing address:
  • Phone: 626-592-8909
  • Fax: 714-456-5014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number86462
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: