MEDICARE: MS. KATHY M WONG PHARM.D.

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	13894	NV

General Provider Information

NPI Number	:	1598871949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHY M WONG PHARM.D.

Provider Business Mailing Address
First Line	:	647 11TH AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-3612
Country	:	US
Telephone Number	:	415-751-3147
Fax Number	:

Provider Business Practice Location Address
First Line	:	3315 CHANATE RD
Second Line	:	SUITE 1E
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-1736
Country	:	US
Telephone Number	:	707-570-3816
Fax Number	:

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/08/2007

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