Provider Demographics
NPI:1538443999
Name:WONG, BILL C (RPH)
Entity type:Individual
Prefix:DR
First Name:BILL
Middle Name:C
Last Name:WONG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:875 BLAKE WILBUR DR # CC1101
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-2205
Mailing Address - Country:US
Mailing Address - Phone:650-838-0429
Mailing Address - Fax:650-838-0447
Practice Address - Street 1:875 BLAKE WILBUR DR # CC1101
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-2205
Practice Address - Country:US
Practice Address - Phone:650-838-0429
Practice Address - Fax:650-838-0447
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH38352183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist