MEDICARE: DR. WEI WEN 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	20-053956	NY

General Provider Information

NPI Number	:	1265752661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WEI WEN WONG PHARM. D.

Provider Business Mailing Address
First Line	:	8738 16TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214
Country	:	US
Telephone Number	:	917-362-9268
Fax Number	:

Provider Business Practice Location Address
First Line	:	8738 16TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4526
Country	:	US
Telephone Number	:	917-362-9268
Fax Number	:

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

Provider Enumeration Date	:	06/08/2010
Last Update Date	:	06/08/2010

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