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General NPI Number Information
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NPI Number | 1487295226
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Entity Type | Individual
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Provider Name | AMANDA WONG PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/02/2019
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 4929 VAN NUYS BLVD
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-1702
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Country | US
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Telephone | 818-981-7111
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Fax |
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Provider Business Mailing Address
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Address Line | 1011 S SERRANO AVE APT 114
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City | LOS ANGELES
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State | CA
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Zip | 90006-3862
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Country | US
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Telephone | 469-231-8563
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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 | 79603
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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 | 63569
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License Number State | TX
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