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General NPI Number Information
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NPI Number | 1972279560
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Entity Type | Individual
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Provider Name | ERICA YA-AI WONG
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Gender | Female
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Dates
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Enumeration Date | 08/23/2021
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Last Update Date | 08/23/2021
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Provider Practice Location Address
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Address Line | 4202 ROSS AVE
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City | DALLAS
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State | TX
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Zip | 75204-5116
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Country | US
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Telephone | 214-584-2484
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Fax |
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Provider Business Mailing Address
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Address Line | 810 LAKE CAROLYN PKWY APT 419
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City | IRVING
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State | TX
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Zip | 75039-4185
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Country | US
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Telephone | 832-713-0103
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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 | 68687
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License Number State | TX
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