Healthcare Provider Details

I. General information

NPI: 1730505165
Provider Name (Legal Business Name): JASON Y WONG PHARMD, APH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2014
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PLAZA DR
ROSEVILLE CA
95661-3037
US

IV. Provider business mailing address

1 MEDICAL PLAZA DR
ROSEVILLE CA
95661-3037
US

V. Phone/Fax

Practice location:
  • Phone: 916-781-1414
  • Fax:
Mailing address:
  • Phone: 916-781-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number70858
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number70858
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number70858
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number058795
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code1835C0206X
TaxonomyCardiology Pharmacist
License Number10186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: