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General NPI Number Information
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NPI Number | 1881613339
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Entity Type | Individual
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Provider Name | TONY WAN PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 50 ALESSANDRO PL STE A50
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City | PASADENA
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State | CA
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Zip | 91105-3162
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Country | US
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Telephone | 626-858-8521
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Fax |
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Provider Business Mailing Address
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Address Line | 1112 S GOLDEN WEST AVE # 103
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City | ARCADIA
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State | CA
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Zip | 91007-7416
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Country | US
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Telephone | 626-447-9936
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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 | 45556
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License Number State | CA
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