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NPI Code Detail

MEDICARE: SAMUEL WONG PHARM.D, MBA

MEDICARE: SAMUEL WONG PHARM.D, MBA
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
1183500000XPharmacistRPH23912CA

General Provider Information

NPI Number : 1124492178
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMUEL WONG PHARM.D, MBA
Provider Business Mailing Address
First Line : 15858 LONDELIUS ST
Second Line :
City : NORTH HILLS
State : CA
Zip : 91343-4840
Country : US
Telephone Number : 818-808-9721
Fax Number :
Provider Business Practice Location Address
First Line : 15858 LONDELIUS ST
Second Line :
City : NORTH HILLS
State : CA
Zip : 91343-4840
Country : US
Telephone Number : 818-808-9721
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2015
Last Update Date : 11/13/2015

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