MEDICARE: SOO WONG RPH

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	67155	CA

General Provider Information

NPI Number	:	1447818380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOO WONG RPH

Provider Business Mailing Address
First Line	:	167 MARIPOSA AVE
Second Line	:
City	:	DALY CITY
State	:	CA
Zip	:	94015-2172
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6843 MISSION ST
Second Line	:
City	:	DALY CITY
State	:	CA
Zip	:	94014-2006
Country	:	US
Telephone Number	:	650-992-9490
Fax Number	:

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

Provider Enumeration Date	:	06/05/2019
Last Update Date	:	06/05/2019

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Directions to “ SOO WONG RPH” Practice Location

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