Healthcare Provider Details

I. General information

NPI: 1265835268
Provider Name (Legal Business Name): PEKKEI WONG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2014
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 HIGHWAY 73
ATCHISON KS
66002-5102
US

IV. Provider business mailing address

1920 HIGHWAY 73
ATCHISON KS
66002-5102
US

V. Phone/Fax

Practice location:
  • Phone: 913-367-6142
  • Fax: 913-367-9698
Mailing address:
  • Phone: 913-367-6142
  • Fax: 913-367-9698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-16618
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: