Healthcare Provider Details

I. General information

NPI: 1982900569
Provider Name (Legal Business Name): BILL M. WONG PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 01/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 SOUTH AIRPORT BLVD
SOUTH SAN FRANCISCO CA
94080
US

IV. Provider business mailing address

PO BOX 304
SAN BRUNO CA
94066
US

V. Phone/Fax

Practice location:
  • Phone: 650-872-0637
  • Fax:
Mailing address:
  • Phone: 650-872-0637
  • Fax: 650-872-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number30982
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: