=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780545947
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VANESSA MARIE WONG PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2025
-----------------------------------------------------
Last Update Date | 11/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 S 47TH AVE
-----------------------------------------------------
City | RIDGEFIELD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98642-7773
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-309-4793
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8005 NE PARKWAY DR # P112
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98662-6407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-990-6622
-----------------------------------------------------
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 | PH70018007
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------