Provider Demographics
NPI:1235417445
Name:WONG, MELISSA (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39755 DATE ST STE 207
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2008
Mailing Address - Country:US
Mailing Address - Phone:951-238-0546
Mailing Address - Fax:
Practice Address - Street 1:8938 TRAUTWEIN RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-9401
Practice Address - Country:US
Practice Address - Phone:951-656-3394
Practice Address - Fax:951-656-3094
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-22
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50402183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist