=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659692705
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FANG-JIUN JENNIFER WANG PHARMACIST
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2010
-----------------------------------------------------
Last Update Date | 06/11/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5490 WHITTIER BLVD
-----------------------------------------------------
City | COMMERCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90022-4113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-721-9718
-----------------------------------------------------
Fax | 323-721-7210
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5490 WHITTIER BLVD
-----------------------------------------------------
City | COMMERCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90022-4113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-721-9718
-----------------------------------------------------
Fax | 323-721-7210
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH43537
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------