Provider Demographics
NPI:1528338951
Name:KWAK, WON C (PHARM D)
Entity type:Individual
Prefix:MR
First Name:WON
Middle Name:C
Last Name:KWAK
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6787 COLE AVE APT 128
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-2515
Mailing Address - Country:US
Mailing Address - Phone:909-864-8584
Mailing Address - Fax:
Practice Address - Street 1:14101 FRANCISQUITO AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-6145
Practice Address - Country:US
Practice Address - Phone:626-814-9342
Practice Address - Fax:626-960-5487
Is Sole Proprietor?:No
Enumeration Date:2012-01-02
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59038183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist