Provider Demographics
NPI:1033109384
Name:LO, IRENE WONG (RPH)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:WONG
Last Name:LO
Suffix:
Gender:F
Credentials:RPH
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Mailing Address - Street 1:3851 ROGER BROOKE DR
Mailing Address - Street 2:BROOKE ARMY MEDICAL CENTER MCHE-QD/CREDNTIALS
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4501
Mailing Address - Country:US
Mailing Address - Phone:210-916-4682
Mailing Address - Fax:210-916-3481
Practice Address - Street 1:3851 ROGER BROOKE DR
Practice Address - Street 2:BROOKE ARMY MEDICAL CENTER MCHE-QD/CREDNTIALS
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4501
Practice Address - Country:US
Practice Address - Phone:210-916-4682
Practice Address - Fax:210-916-3481
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
TX24280183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist