MEDICARE: DR. TAM LE 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
1	183500000X	Pharmacist	65103	WA

General Provider Information

NPI Number	:	1073869608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAM LE WONG PHARM.D

Provider Business Mailing Address
First Line	:	1720 N WINCHESTER CT
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-7706
Country	:	US
Telephone Number	:	509-414-6901
Fax Number	:

Provider Business Practice Location Address
First Line	:	12120 N DIVISION ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99218-1905
Country	:	US
Telephone Number	:	509-465-4433
Fax Number	:	509-465-4427

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

Provider Enumeration Date	:	08/01/2012
Last Update Date	:	08/01/2012

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