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General NPI Number Information
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NPI Number | 1457721441
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Entity Type | Individual
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Provider Name | NATHAN WONG PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/02/2015
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Last Update Date | 10/19/2023
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Provider Practice Location Address
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Address Line | 2825 CAPITOL AVE STE 3N108
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City | SACRAMENTO
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State | CA
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Zip | 95816-6039
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Country | US
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Telephone | 916-887-4680
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Fax | 916-739-3208
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Provider Business Mailing Address
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Address Line | 2825 CAPITOL AVE STE 3N108
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City | SACRAMENTO
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State | CA
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Zip | 95816-6039
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Country | US
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Telephone | 916-887-4680
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Fax | 916-739-3208
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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 | RPH71981
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | APH10720
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | APH10720
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License Number State | CA
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