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General NPI Number Information
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NPI Number | 1700813060
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Entity Type | Organization
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Legal Business Name | EMILY CHU WONG
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 03/28/2017
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Provider Practice Location Address
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Address Line | 640 N BROADWAY STE 3
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City | LOS ANGELES
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State | CA
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Zip | 90012-2815
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Country | US
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Telephone | 213-617-3333
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Fax | 213-617-3318
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Provider Business Mailing Address
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Address Line | 640 N BROADWAY STE 3
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City | LOS ANGELES
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State | CA
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Zip | 90012-2815
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Country | US
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Telephone | 213-617-3333
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Fax | 213-617-3318
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Authorized Official
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Title or Position | RPH
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Name | EMILY WONG
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Credential | RPH
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Telephone | 213-617-3333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY22892
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License Number State | CA
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