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General NPI Number Information
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NPI Number | 1356742878
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Entity Type | Individual
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Provider Name | AILEEN WONG PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/16/2014
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Last Update Date | 09/16/2014
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Provider Practice Location Address
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Address Line | 8011 VENTURA ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-6429
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Country | US
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Telephone | 505-217-2860
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Fax |
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Provider Business Mailing Address
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Address Line | 6601 TENNYSON ST NE APT 12104
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-8161
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Country | US
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Telephone | 505-917-7005
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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 | RP00008252
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License Number State | NM
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