MEDICARE: JEANNA 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	S013021	AZ
2	183500000X	Pharmacist	051.290903	IL

General Provider Information

NPI Number	:	1538454913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNA WONG PHARMD

Provider Business Mailing Address
First Line	:	5110 S POWER RD
Second Line	:	T1959
City	:	MESA
State	:	AZ
Zip	:	85212-4201
Country	:	US
Telephone Number	:	480-281-0269
Fax Number	:

Provider Business Practice Location Address
First Line	:	5110 S POWER RD
Second Line	:	T1959
City	:	MESA
State	:	AZ
Zip	:	85212-4201
Country	:	US
Telephone Number	:	480-281-0269
Fax Number	:

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

Provider Enumeration Date	:	06/14/2011
Last Update Date	:	06/14/2011

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Directions to “ JEANNA WONG PHARMD” Practice Location

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