Healthcare Provider Details

I. General information

NPI: 1801819362
Provider Name (Legal Business Name): LAURA ANN WONG PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 STONY POINT RD
SANTA ROSA CA
95401-4122
US

IV. Provider business mailing address

144 STONY POINT RD
SANTA ROSA CA
95401-4122
US

V. Phone/Fax

Practice location:
  • Phone: 707-521-4585
  • Fax:
Mailing address:
  • Phone: 707-521-4590
  • Fax: 707-521-4599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number45044
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: