Healthcare Provider Details

I. General information

NPI: 1275814956
Provider Name (Legal Business Name): ELEANOR WONG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7041 PACIFIC AVE
TACOMA WA
98408-7220
US

IV. Provider business mailing address

7041 PACIFIC AVE
TACOMA WA
98408-7220
US

V. Phone/Fax

Practice location:
  • Phone: 253-474-8500
  • Fax: 253-474-0253
Mailing address:
  • Phone: 253-474-8500
  • Fax: 253-474-0253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH 60219977
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: