MEDICARE: MR. BRANNON 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	183500000X	Pharmacist	71591	CA

General Provider Information

NPI Number	:	1841694999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRANNON WONG

Provider Business Mailing Address
First Line	:	534 S BAYVIEW AVE
Second Line	:
City	:	SUNNYVALE
State	:	CA
Zip	:	94086-6250
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 PALMETTO AVE
Second Line	:
City	:	PACIFICA
State	:	CA
Zip	:	94044-1842
Country	:	US
Telephone Number	:	650-355-9901
Fax Number	:

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

Provider Enumeration Date	:	10/17/2014
Last Update Date	:	10/17/2014

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Directions to “ MR. BRANNON WONG ” Practice Location

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