MEDICARE: KENNETH WONG PHARMD.

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
1	183500000X	Pharmacist	19442	NV

General Provider Information

NPI Number	:	1033680285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH WONG PHARMD.

Provider Business Mailing Address
First Line	:	3160 N RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4533
Country	:	US
Telephone Number	:	702-658-3870
Fax Number	:

Provider Business Practice Location Address
First Line	:	3160 N RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4533
Country	:	US
Telephone Number	:	702-658-3870
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2018
Last Update Date	:	12/16/2018

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Directions to “ KENNETH WONG PHARMD.” Practice Location

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