MEDICARE: CHRISTINE WANG 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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PH233752	MA
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	056073	NY

General Provider Information

NPI Number	:	1093070690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE WANG PHARMD

Provider Business Mailing Address
First Line	:	8000 UTOPIA PKWY
Second Line	:	ST. ALBERT'S HALL ROOM 114
City	:	JAMAICA
State	:	NY
Zip	:	11439-9000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 COMMUNITY DR
Second Line	:	SUITE 130
City	:	GREAT NECK
State	:	NY
Zip	:	11021-5503
Country	:	US
Telephone Number	:	516-918-4307
Fax Number	:

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

Provider Enumeration Date	:	07/10/2012
Last Update Date	:	06/27/2019

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