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General NPI Number Information
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NPI Number | 1194804864
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Entity Type | Organization
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Legal Business Name | STEPHEN SHING WONG
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 07/25/2014
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Provider Practice Location Address
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Address Line | 4600 47TH AVE STE 110
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City | SACRAMENTO
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State | CA
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Zip | 95824-3923
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Country | US
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Telephone | 916-428-7500
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Fax | 916-421-0506
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Provider Business Mailing Address
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Address Line | 4600 47TH AVE STE 110
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City | SACRAMENTO
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State | CA
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Zip | 95824-3923
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Country | US
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Telephone | 916-428-7500
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Fax | 916-421-0506
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Authorized Official
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Title or Position | OWNER PHCST
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Name | STEPHEN WONG
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Credential |
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Telephone | 916-428-7500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY40590
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License Number State | CA
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