Healthcare Provider Details

I. General information

NPI: 1316310154
Provider Name (Legal Business Name): JESSICA WUNG PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2015
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 CENTRE ST
NATICK MA
01760-1804
US

IV. Provider business mailing address

6 CENTRE ST
NATICK MA
01760-1804
US

V. Phone/Fax

Practice location:
  • Phone: 508-314-3010
  • Fax:
Mailing address:
  • Phone: 508-314-3010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH234739
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: