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General NPI Number Information
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NPI Number | 1699287938
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Entity Type | Individual
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Provider Name | MONIKA STEPHANIE WAN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/26/2017
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Last Update Date | 10/26/2017
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Provider Practice Location Address
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Address Line | 710 RIO RANCHO ROAD
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City | POMONA
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State | CA
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Zip | 91766
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Country | US
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Telephone | 909-634-3152
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Fax |
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Provider Business Mailing Address
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Address Line | 2960 HUNTINGTON DR UNIT 80965
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City | SAN MARINO
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State | CA
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Zip | 91118-7048
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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 | 77743
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License Number State | CA
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