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General NPI Number Information
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NPI Number | 1558426973
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Entity Type | Organization
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Legal Business Name | GRACE WANG
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2241 MICHAEL DR
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City | NEWBURY PARK
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State | CA
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Zip | 91320-3340
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Country | US
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Telephone | 805-375-6650
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Fax | 805-375-6654
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Provider Business Mailing Address
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Address Line | 2241 MICHAEL DR
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City | NEWBURY PARK
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State | CA
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Zip | 91320-3340
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER PHARMACIST
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Name | GRACE WANG
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Credential | RPH
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Telephone | 805-375-6650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY41868
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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