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General NPI Number Information
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NPI Number | 1477925725
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Entity Type | Individual
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Provider Name | JUN WANG
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Gender | Male
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Dates
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Enumeration Date | 10/27/2015
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Last Update Date | 10/27/2015
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Provider Practice Location Address
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Address Line | 835 PARK AVE
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City | BLOOMFIELD
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State | CT
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Zip | 06002-2469
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Country | US
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Telephone | 860-242-5551
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Fax |
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Provider Business Mailing Address
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Address Line | 99 CAMBRIDGE ST
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City | WEST HARTFORD
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State | CT
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Zip | 06110-2306
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Country | US
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Telephone | 646-823-1151
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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 | PCT.0013321
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License Number State | CT
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