Healthcare Provider Details

I. General information

NPI: 1154325975
Provider Name (Legal Business Name): YVONNE M WONG RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34400 MISSION BLVD
UNION CITY CA
94587-3604
US

IV. Provider business mailing address

34400 MISSION BLVD
UNION CITY CA
94587-3604
US

V. Phone/Fax

Practice location:
  • Phone: 510-429-6426
  • Fax: 510-475-5697
Mailing address:
  • Phone: 510-429-6426
  • Fax: 510-475-5697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number44895
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: