MEDICARE: MR. WAI H VONG BS PHARM

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	13730	NV
2	183500000X	Pharmacist	50545	CA

General Provider Information

NPI Number	:	1356536320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WAI H VONG BS PHARM

Provider Business Mailing Address
First Line	:	1001 S RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-6232
Country	:	US
Telephone Number	:	702-877-2162
Fax Number	:	702-877-1442

Provider Business Practice Location Address
First Line	:	1001 S RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-6232
Country	:	US
Telephone Number	:	702-877-2162
Fax Number	:	702-877-1442

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

Provider Enumeration Date	:	09/12/2007
Last Update Date	:	09/12/2007

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