MEDICARE: DR. SHINMANN WANG 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	60359	CA

General Provider Information

NPI Number	:	1891081691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHINMANN WANG PHARMD

Provider Business Mailing Address
First Line	:	747 GRAND AVE
Second Line	:	TARGET PHARMACY (T2179)
City	:	DIAMOND BAR
State	:	CA
Zip	:	91765-8400
Country	:	US
Telephone Number	:	909-610-2150
Fax Number	:	909-610-2150

Provider Business Practice Location Address
First Line	:	747 GRAND AVE
Second Line	:	TARGET PHARMACY (T2179)
City	:	DIAMOND BAR
State	:	CA
Zip	:	91765-8400
Country	:	US
Telephone Number	:	909-610-2150
Fax Number	:	909-610-2150

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

Provider Enumeration Date	:	06/21/2011
Last Update Date	:	06/21/2011

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