Provider Demographics
NPI:1033512827
Name:WANG, GUAN-JIE (PHARM D)
Entity Type:Individual
Prefix:
First Name:GUAN-JIE
Middle Name:
Last Name:WANG
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 1:1334 W LULLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-4519
Mailing Address - Country:US
Mailing Address - Phone:210-683-8714
Mailing Address - Fax:
Practice Address - Street 1:119 HUIZAR REAR A
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78214-2707
Practice Address - Country:US
Practice Address - Phone:180-054-1495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51182183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist