MEDICARE: ELTON Y. 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	333600000X	Pharmacy	PHY38028	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0579447	OTHER		NCPDP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649263302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELTON Y. WONG

Provider Business Mailing Address
First Line	:	719 E 12TH ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94606-3624
Country	:	US
Telephone Number	:	510-839-8839
Fax Number	:	510-839-8696

Provider Business Practice Location Address
First Line	:	719 E 12TH ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94606-3624
Country	:	US
Telephone Number	:	510-839-8839
Fax Number	:	510-839-8696

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ELTON Y WONG
Credential	:	PHARM D
Telephone Number	:	510-839-8839

Provider Enumeration Date	:	08/29/2005
Last Update Date	:	06/16/2008

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