Provider Demographics
NPI:1225446370
Name:WONG, ERIC CAMERON (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:CAMERON
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 1:1300 ROCKEFELLER AVE
Mailing Address - Street 2:STE 150
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-1632
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1300 ROCKEFELLER AVE
Practice Address - Street 2:STE 150
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1632
Practice Address - Country:US
Practice Address - Phone:425-297-5220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS020653183500000X
WAPH60577580183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist