Provider Demographics
NPI:1225315088
Name:WONG, ANTHONY KAMSENG (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:KAMSENG
Last Name:WONG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6280 JOSIE ST
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-9106
Mailing Address - Country:US
Mailing Address - Phone:209-676-9658
Mailing Address - Fax:
Practice Address - Street 1:1591 GEER RD
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-3200
Practice Address - Country:US
Practice Address - Phone:209-696-6648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57003183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist