Healthcare Provider Details

I. General information

NPI: 1336869775
Provider Name (Legal Business Name): WILSON VUONG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 08/29/2022
Certification Date: 08/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4131 GEARY BLVD
SAN FRANCISCO CA
94118-3101
US

IV. Provider business mailing address

4131 GEARY BLVD # B10
SAN FRANCISCO CA
94118-3101
US

V. Phone/Fax

Practice location:
  • Phone: 415-833-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number86522
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: