MEDICARE: MS. FLORA YAN WONG

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	44357	CA

General Provider Information

NPI Number	:	1225316920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. FLORA YAN WONG

Provider Business Mailing Address
First Line	:	2610 BISHOP DR
Second Line	:	T-0949
City	:	SAN RAMON
State	:	CA
Zip	:	94583-2338
Country	:	US
Telephone Number	:	925-867-0245
Fax Number	:

Provider Business Practice Location Address
First Line	:	2610 BISHOP DR
Second Line	:	T-0949
City	:	SAN RAMON
State	:	CA
Zip	:	94583-2338
Country	:	US
Telephone Number	:	925-867-0245
Fax Number	:

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

Provider Enumeration Date	:	07/28/2011
Last Update Date	:	07/28/2011

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