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NPI Code Detail

MEDICARE: CAROLYN MARIE WONG PHARM.D.

MEDICARE: CAROLYN MARIE WONG PHARM.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistPH00040088WA

General Provider Information

NPI Number : 1033105671
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLYN MARIE WONG PHARM.D.
Provider Business Mailing Address
First Line : 11301 SE 10TH ST
Second Line : #268
City : VANCOUVER
State : WA
Zip : 98664-6100
Country : US
Telephone Number : 360-828-5532
Fax Number :
Provider Business Practice Location Address
First Line : 400 NE MOTHER JOSEPH PL
Second Line :
City : VANCOUVER
State : WA
Zip : 98664-3200
Country : US
Telephone Number : 360-514-7589
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2005
Last Update Date : 07/08/2007

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