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General NPI Number Information
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NPI Number | 1609274489
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Entity Type | Individual
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Provider Name | CASEY WANG
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Gender | Female
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Dates
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Enumeration Date | 12/10/2014
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Last Update Date | 12/10/2014
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Provider Practice Location Address
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Address Line | 4172 N 1ST ST
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City | FRESNO
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State | CA
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Zip | 93726-4312
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Country | US
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Telephone | 925-243-0124
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Fax |
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Provider Business Mailing Address
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Address Line | 457 DOLORES CT
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City | PLEASANTON
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State | CA
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Zip | 94566-7668
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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 |
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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 | 72135
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License Number State | CA
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