Healthcare Provider Details

I. General information

NPI: 1457446304
Provider Name (Legal Business Name): BETTY WONG PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 MORSE AVE
SACRAMENTO CA
95825-2115
US

IV. Provider business mailing address

2025 MORSE AVE
SACRAMENTO CA
95825-4413
US

V. Phone/Fax

Practice location:
  • Phone: 916-973-5655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43392
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: