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General NPI Number Information
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NPI Number | 1053931303
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Entity Type | Individual
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Provider Name | WILSON WONG PHARMD
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Gender | Male
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Dates
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Enumeration Date | 04/16/2020
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Last Update Date | 04/16/2020
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Provider Practice Location Address
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Address Line | CVS PHARMACY #450 3401 WALNUT ST
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City | PHILADELPHIA
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State | PA
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Zip | 19107
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Country | US
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Telephone | 215-662-1333
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 VINE ST APT 806
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City | PHILADELPHIA
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State | PA
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Zip | 19107-1736
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Country | US
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Telephone | 267-331-1352
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP446897
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License Number State | PA
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