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General NPI Number Information
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NPI Number | 1194130062
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Entity Type | Individual
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Provider Name | DOUGLAS WONG
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Gender | Male
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Dates
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Enumeration Date | 06/30/2014
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 700 E KENNEDY RD
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City | NORTH WALES
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State | PA
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Zip | 19454-5612
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Country | US
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Telephone | 215-628-0867
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Fax | 845-483-1649
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Provider Business Mailing Address
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Address Line | 700 E KENNEDY RD
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City | NORTH WALES
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State | PA
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Zip | 19454-5612
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Country | US
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Telephone | 215-628-0867
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Fax | 845-483-1649
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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 | 30301
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP043566R
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH18267
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 06823
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License Number State | NV
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