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General NPI Number Information
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NPI Number | 1134674039
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Entity Type | Individual
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Provider Name | BRANDON WONG RPH
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Gender | Male
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Dates
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Enumeration Date | 08/20/2016
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Last Update Date | 08/20/2016
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Provider Practice Location Address
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Address Line | 25622 CROWN VALLEY PKWY
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City | LADERA RANCH
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State | CA
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Zip | 92694-0464
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Country | US
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Telephone | 949-347-6751
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Fax |
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Provider Business Mailing Address
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Address Line | 2904 CABALLISTA DEL SUR
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-3446
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Country | US
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Telephone | 949-361-1006
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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 | 67324
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License Number State | CA
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