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General NPI Number Information
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NPI Number | 1992176259
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Entity Type | Individual
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Provider Name | KELLY WONG PHARM D
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Gender | Female
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Dates
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Enumeration Date | 10/13/2015
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Last Update Date | 10/13/2015
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Provider Practice Location Address
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Address Line | 1120 S NT VERNON AVE
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City | COLTON
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State | CA
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Zip | 92324
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Country | US
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Telephone | 909-783-0390
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Fax |
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Provider Business Mailing Address
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Address Line | 10871 CARRIAGE DR
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City | ALTA LOMA
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State | CA
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Zip | 91737
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Country | US
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Telephone | 909-921-8492
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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 | RPH40823
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License Number State | CA
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