Provider Demographics
NPI:1194030270
Name:LOONG, WAIKIN HARRY (RPH)
Entity Type:Individual
Prefix:
First Name:WAIKIN
Middle Name:HARRY
Last Name:LOONG
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 1:16406 BEAR MEADOW CIR
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-1904
Mailing Address - Country:US
Mailing Address - Phone:562-926-5406
Mailing Address - Fax:
Practice Address - Street 1:802 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4213
Practice Address - Country:US
Practice Address - Phone:323-722-3782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30731183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist