MEDICARE: SUSAN L 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	0008033	OR
2	183500000X	Pharmacist	RPH 44277	CA
3	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	RPH-0008033	OR
4	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	RPH 44277	CA

General Provider Information

NPI Number	:	1427314806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN L WONG

Provider Business Mailing Address
First Line	:	3300 PORTLAND RD
Second Line	:
City	:	NEWBERG
State	:	OR
Zip	:	97132-5400
Country	:	US
Telephone Number	:	503-537-1383
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 PORTLAND RD
Second Line	:
City	:	NEWBERG
State	:	OR
Zip	:	97132-5400
Country	:	US
Telephone Number	:	503-537-1383
Fax Number	:

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

Provider Enumeration Date	:	04/10/2012
Last Update Date	:	04/25/2017

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Directions to “ SUSAN L WONG ” Practice Location

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