Provider Demographics
NPI:1164004495
Name:WONGBI, VICTORINE ALMA NTEMBO (PHARMD)
Entity Type:Individual
Prefix:
First Name:VICTORINE ALMA
Middle Name:NTEMBO
Last Name:WONGBI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6992 170TH TRL NW
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-7306
Mailing Address - Country:US
Mailing Address - Phone:612-532-8511
Mailing Address - Fax:
Practice Address - Street 1:1315 HIGHWAY 25 N
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-1937
Practice Address - Country:US
Practice Address - Phone:763-682-2963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN124495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist