Healthcare Provider Details

I. General information

NPI: 1306468319
Provider Name (Legal Business Name): WEN GAO HUANG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E 64TH ST
NEW YORK NY
10065-7471
US

IV. Provider business mailing address

1720 64TH ST
BROOKLYN NY
11204-2905
US

V. Phone/Fax

Practice location:
  • Phone: 212-605-3797
  • Fax:
Mailing address:
  • Phone: 646-270-9169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number052047
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: