MEDICARE: FIONA WU 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	068481	NY

General Provider Information

NPI Number	:	1699430801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FIONA WU PHARMD

Provider Business Mailing Address
First Line	:	2865 W 23RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-2356
Country	:	US
Telephone Number	:	646-321-6791
Fax Number	:

Provider Business Practice Location Address
First Line	:	3071 E MAIN ST
Second Line	:
City	:	MOHEGAN LAKE
State	:	NY
Zip	:	10547-1542
Country	:	US
Telephone Number	:	665-091-4526
Fax Number	:

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

Provider Enumeration Date	:	11/02/2021
Last Update Date	:	11/02/2021

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