Provider Demographics
NPI:1033471362
Name:WONG, ANTHONY (RPH)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 ATLANTIS AVE
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-1908
Mailing Address - Country:US
Mailing Address - Phone:609-978-0930
Mailing Address - Fax:609-978-5110
Practice Address - Street 1:733 ROUTE 72 W
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2864
Practice Address - Country:US
Practice Address - Phone:609-978-0930
Practice Address - Fax:609-978-5110
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28 RI02383500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist