Provider Demographics
NPI:1184225070
Name:WANG, RUOBING
Entity Type:Individual
Prefix:
First Name:RUOBING
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 W RICHEY AVE APT 3201
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-9697
Mailing Address - Country:US
Mailing Address - Phone:303-775-4603
Mailing Address - Fax:
Practice Address - Street 1:1200 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-5547
Practice Address - Country:US
Practice Address - Phone:575-624-1439
Practice Address - Fax:575-624-0358
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4254183500000X
NMRP00009392183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist