MEDICARE: MR. RACKY WONG 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	183500000X	Pharmacist	46963	CA

General Provider Information

NPI Number	:	1356683056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RACKY WONG PHARMD

Provider Business Mailing Address
First Line	:	515 JOHN MUIR DR APT 706
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94132-6051
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 JOHN MUIR DR APT 706
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94132-6051
Country	:	US
Telephone Number	:	415-683-1992
Fax Number	:

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

Provider Enumeration Date	:	03/20/2013
Last Update Date	:	03/20/2013

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