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General NPI Number Information
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NPI Number | 1497800825
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Entity Type | Organization
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Legal Business Name | SHUMWONG CORPORATION
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2485 HIGH SCHOOL AVE SUITE 114
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City | CONCORD
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State | CA
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Zip | 94520-1819
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Country | US
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Telephone | 925-682-5600
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Fax | 925-682-0609
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Provider Business Mailing Address
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Address Line | 2485 HIGH SCHOOL AVE SUITE 114
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City | CONCORD
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State | CA
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Zip | 94520-1819
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Country | US
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Telephone | 925-682-5600
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Fax | 925-682-0609
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Authorized Official
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Title or Position | PHARMACIST-IN-CHARGE
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Name | MR. BRIAN RANDALL WONG
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Credential | M.S., RPH
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Telephone | 925-682-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY30974
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License Number State | CA
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