=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679466429
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA SUI YEE WONG
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2025
-----------------------------------------------------
Last Update Date | 05/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20311 OLD HIGHWAY 9 SW
-----------------------------------------------------
City | CENTRALIA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98531-9620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-664-3400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15142 PRESCOTT LOOP SE
-----------------------------------------------------
City | YELM
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98597-7110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-882-8928
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PH60707602
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------