Healthcare Provider Details

I. General information

NPI: 1225521156
Provider Name (Legal Business Name): MICHELLE WANG PHARMD, BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 S SUNSET AVE STE 200
WEST COVINA CA
91790-3940
US

IV. Provider business mailing address

385 S LEMON AVE # E256
WALNUT CA
91789-2727
US

V. Phone/Fax

Practice location:
  • Phone: 626-732-8390
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number81715
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: