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General NPI Number Information
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NPI Number | 1134004179
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Entity Type | Individual
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Provider Name | JACOB WANG PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/08/2025
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Last Update Date | 08/08/2025
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Provider Practice Location Address
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Address Line | 6 QUEEN ST
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City | NEWTOWN
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State | CT
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Zip | 06470-2146
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Country | US
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Telephone | 203-426-2595
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Fax |
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Provider Business Mailing Address
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Address Line | 22 MARIE ALICIA DR
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City | SHELTON
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State | CT
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Zip | 06484-2442
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Country | US
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Telephone | 978-727-4996
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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 | PCT.0017086
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License Number State | CT
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