=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962066332
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANETTE WONG-SING RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2019
-----------------------------------------------------
Last Update Date | 04/30/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1825 ACADEMY AVE
-----------------------------------------------------
City | SANGER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93657-3705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 558-875-2517
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 40560 ROAD 36
-----------------------------------------------------
City | KINGSBURG
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93631-9621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-859-0461
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | RPH30239
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------