MEDICARE: DIANA 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	54174	CA

General Provider Information

NPI Number	:	1396096384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA WONG PHARMD

Provider Business Mailing Address
First Line	:	505 PARNASSUS AVE RM M39C
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-3836
Country	:	US
Telephone Number	:	415-353-1798
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 PARNASSUS AVE RM M39C
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-3836
Country	:	US
Telephone Number	:	415-353-1798
Fax Number	:

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

Provider Enumeration Date	:	10/01/2012
Last Update Date	:	10/01/2012

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Directions to “ DIANA WONG PHARMD” Practice Location

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