Healthcare Provider Details

I. General information

NPI: 1962024836
Provider Name (Legal Business Name): ABBY WONG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 08/22/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S LANCASTER RD
DALLAS TX
75216-7167
US

IV. Provider business mailing address

4500 S LANCASTER RD
DALLAS TX
75216-7167
US

V. Phone/Fax

Practice location:
  • Phone: 214-742-8387
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number36768
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number68882
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: