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General NPI Number Information
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NPI Number | 1558545657
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Entity Type | Individual
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Provider Name | RAYMOND BOB WONG RPH,I
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Gender | Male
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Dates
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Enumeration Date | 12/26/2007
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Last Update Date | 05/01/2009
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Provider Practice Location Address
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Address Line | 50 N MAIN ST
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City | NEW CITY
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State | NY
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Zip | 10956-3719
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Country | US
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Telephone | 845-638-1537
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Fax |
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Provider Business Mailing Address
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Address Line | 214 VALLEY RD
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City | VALLEY COTTAGE
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State | NY
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Zip | 10989-2439
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Country | US
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Telephone | 845-267-8386
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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 | 029376
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License Number State | NY
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