Provider Demographics
NPI:1235671439
Name:WAN, KAREN RITA (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:RITA
Last Name:WAN
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 174
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-0174
Mailing Address - Country:US
Mailing Address - Phone:626-476-8768
Mailing Address - Fax:
Practice Address - Street 1:130 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-2171
Practice Address - Country:US
Practice Address - Phone:626-476-8768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-06
Last Update Date:2016-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74059183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist