Provider Demographics
NPI:1225313356
Name:WANG, JAMIE LYNN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:LYNN
Last Name:WANG
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 1:7922 MACKENZIE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-2721
Mailing Address - Country:US
Mailing Address - Phone:314-638-3535
Mailing Address - Fax:
Practice Address - Street 1:7922 MACKENZIE RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-2721
Practice Address - Country:US
Practice Address - Phone:314-638-3535
Practice Address - Fax:314-638-0351
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011030573183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600307706Medicaid